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An exhibition at the 
National Library of Medicine 
National Institutes of Health • Bethesda, Maryland 

and Disease 

Emotions and Disease 
National Library of Medicine 
Bethesda, Maryland 

November 13, 1996 to May 1, 1997 

and Disease 

An exhibition at the 
National Library of Medicine 

Exhibition Directors: 
Elizabeth Fee 
Esther M. Sternberg 

Visiting Curators: 

Anne Harrington 
Theodore M. Brown 

Friends of the 

National Library of Medicine 

Published in conjunction with the exhibition 
Emotions and Disease, organized by the History of 
Medicine Division, National Library of Medicine 

This project was made possible by the generous 
support of the Charles A. Dana Foundation, the 
John D. and Catherine T. MacArthur Foundation, 
the Fetzer Institute and the National Institute of 
Mental Health 

Copyright © 1997 Friends of the National Library 
of Medicine. All rights reserved 

Printed in the Lnited States of America 

(left) YValther Ryff (d. 1548), Spiegel und Regiment 

der Gesundheyt, Frankfurt, 1555. 

Graphic: Photographic reproduction of woodcut 


(right) Rudolf Yirchow (182 1-1 902), Die 
Celiularpatkologu in ihrtr Eegriindung auf 
Pkysiologisdu unci ' Pathologische Gewebe/ehre, Berlin, 


Exhibition Directors' Statement page vi 

Emotions and Disease in Historical Perspective page 1 
Notes A , 

nu ir r r • page 46 

Checklist for Emotions and Disease page 52 

Acknowledgments 65 

Exhibition Directors' Statement 

The exhibition Emotions and Disease was initially developed 
by the History of Medicine Division of the National Library 
of Medicine, in conjunction with the Third International 
Congress of the International Society for Neuroimmunomod- 
ulation which met at the National Institutes of Health in 
November 1996. The exhibition was intended to provide 
historical perspective and context for the scientific discus- 
sions and presentations at the Congress and to explain to 
the general public the meaning and relevance of scientific 
developments linking neurophysiology to the functioning of 
our immune systems. Using the historical approach, we 
believed we could make these sophisticated scientific devel- 
opments more accessible to a non-specialist audience. The 
historical approach could also be used to show the complex 
relationships between scientific theories, popular ideas, and 
their cultural context. 

One of the paradoxes we found was that the close 
relationship between health, disease, and the emotions 
seemed to be more readily accepted in popular culture than 
within the contemporary scientific community. Why, we 
asked, has the close relationship of emotions to disease been 
so central to the long history of medical practice, yet has been 
regarded with suspicion by some sectors of the modern bio- 
medical community? 

This exhibition evolved as a dialogue between scien- 
tists and historians pursuing answers to these questions. The 
dialogue has been fruitful, although difficult at times. The 
historians involved have had to learn some of the language 
and perspectives of the biomedical sciences, and the scien- 
tists have had to cope with the different language and per- 
spectives of the historians. Working on this exhibition, we 
found that the collaboration across disciplines, indeed across 
the great divide between contemporary science and the 
humanities, can be a rewarding adventure for all participants 
and well worth the occasional linguistic, philosophical, and 
political struggles involved. The results appeal to and engage 
a variety of audiences from students of science and history to 
professionals in these fields. 


We would like to thank Dr. Sheldon Cohen, himself 
a model of interdisciplinary work between the history of med- 
icine and contemporary science, for introducing us: Elizabeth 
Fee, a historian of medicine, and Esther Sternberg, a neuro- 
endocrinimmunologist. Together we developed the general 
outline of the exhibition and invited Anne Harrington and 
Theodore M. Brown to serve as visiting curators, responsible 
for the overall intellectual development of the exhibition and 
for writing the panels, captions, and catalogue materials. 
Gretchen Hermes joined us for a summer as assistant curator. 
Key to the success of the exhibition were our panel of distin- 
guished consultants and the timely and generous support of 
the Charles A. Dana Foundation, the John D. and Catherine 
T. MacArthur Foundation, the Fetzer Institute, and the 
National Institute of Mental Health. Also essential were the 
invaluable contributions of Lou Storey as exhibition designer, 
Anne Whitaker as collections manager, and Patricia Tuohy as 
exhibition manager. The acknowledgments in this catalogue 
recognize the many individuals who contributed to this pro- 
ject and to whom we are grateful. 

The talented people involved in the creation of this 
exhibition have worked together to show how historical 
research and contemporary science, presented through cre- 
ative use of visual design and modern media, can be effective 
in bringing new forms of scientific understanding to the pub- 
lic. We believe that the history of science and medicine can 
help us understand and appreciate the frontiers of science 
while also demonstrating the ways in which our forebears 
have addressed, explored, and puzzled over the same issues 
that engage us today. By addressing past and current contro- 
versies in science and medicine, we hope to captivate public- 
interest and help build awareness of the need for further his- 
torical and medical research. As in the case of Emotions and 
Disease, federal agencies and private foundations can work 
together to produce attractive and instructive educational 
materials on health and medicine for the public. We hope this 
project may serve as an inspiration and model for many other 
such efforts. 

Elizabeth Fee, Ph.D. 

Chief, History of Medicine Division 

National Library of Medicine 

Esther M. Sternberg, M.D. 

Chief, Section on Neuroendocrine Immunology and 
National Institute of Mental Health 

\ 11 

Emotions and Disease in 
Historical Perspective 

Theodore M. Brown 

In the world today, science is about to validate long-held 
beliefs about the relationship between emotions and disease. 
A new field of research, exploring the connections between 
the neuroendocrine and immune systems, has already pro- 
duced exciting discoveries which promise to confirm, in the 
most modern scientific terms, the influence of emotions on 
the onset, course, and remission of disease. For centuries and 
long before the first glimmerings of modern science, physi- 
cians and non-physicians alike have acknowledged that the 
way people felt in their minds could influence the way they 
responded in their bodies. When prevailing medical theory 
denied the very possibility of such interactions, common 
experience and sometimes quite startling clinical encounters 
suggested otherwise. The relationship between emotions and 
disease has often been like a haunting melody that could not 
be forgotten, while it has sometimes surged into full chorus. 

It has been this way ever since the beginning of the 
Western scientific tradition. Although the specific terms of 
discussion have changed many times in the course of history 
and even though medicine has been transformed several 
times in the process, perceptive observers have regularly 
returned to the study of the interactions of body, mind and 
medicine. These interactions have continued to fascinate, 
even though they have never been completely understood. 
At times when the majority of physicians and scientists 
focused attention elsewhere, a minority refused to let the 
issues die. Now the issues are back again, front and center, in 
the convergent focus of the lay public, clinical medicine, and 
modern laboratory science. This exhibition highlights signifi- 
cant achievements and major turning points on a well-trav- 
eled historical road which is taking a turn yet again as it leads 
into the promising but indefinite future. 


Hippocrates. Hippokratous 


This is a Renaissance edition of works by Hippocrates, 
with parallel text in Greek and Latin. 

The Balance of Passions 

This story begins, as did so many other components of our 
culture, in Greek and Roman antiquity where medicine first 
emerged as a secular activity independent of religion. There 
Hippocrates (ca. 460 B.C.-ca. 370 B.C.) and his followers com- 
bined naturalistic craft know ledge with ancient science and 
philosophy to produce the first systematic explanations of the 
behavior of the human body in health and illness. Distant 
ancestors of modern biomedical scientists began to explore 
the solid and fluid parts of the human organism for keys to 
unlock the hidden mechanisms of disease. They made the 
first attempts to understand emotions as mental phenomena 
which had surprising and complex connections to physiologi- 
cal order and pathological disorder. 

Early Western physicians recognized that emotions 
were of essential significance, however, their medical systems 
were actually weighted more heavily on the body side of the 
mind-body balance. The dominant theory of Hippocrates and 
his successors was that of the four "humors": black bile, yel- 
low bile, phlegm, and blood. When these humors were in bal- 
ance, health prevailed; when they were out of balance or viti- 
ated in some way, disease took over. The goal of an individ- 
ual's personal hygiene was to keep the humors in balance, 
and the goal of medical therapy was to restore humoral equi- 
librium by adjusting diet, exercise, and the management of 
the body's evacuations (e.g.: the blood, urine, feces, perspira- 

Jjl|l§KiiSs3r ^SsS^s™~* i 

i S^SSEi-Sis! ^^^^^^^ 1 

Johannes de Ketham (fl. 1455-1470). Fasciculus Medicinae, Vienna, 1495 

Johannes de Ketham. a professor of medicine in Vienna, published 
Fasciculus Medicinae, which included illustrations on bloodletting and 

urine flasks showing the "resemblance of the elements and the bodily consti- 
tutions." This is an English translation of Latin text. 


tion, etc. ). 1 he scene from Walther Ryff's Spiegel und 
Regiment and the diagram from Johannes de Ketham s 
Fasciculus Medicinae, although both from later periods, clearly 
illustrate these classical themes. 

Emphasizing the humors gave classical medicine 
what modern philosophers call a "reductionist" bias— the 
humors were used to explain more complex phenomena like 
emotional states in much simpler physical terms. For exam- 
ple, when a patient was melancholy, physicians assumed that 
his or her complicated feelings of sadness and depression 
resulted from the physical excess of black bile. Likewise, 
an excess of yellow bile was thought to make a person angry 
and impulsive. In the Hippocratic treatise The Sacred Disease, 
the author explains that "those maddened through bile are 
noisy, evil-doers and restless, always doing something inop- 
portune"'; this explanation assumes that emotions are the 
more complicated consequences of the simpler and prior 
humoral causes. 

Even in the unmistakably reductionist Hippocratic 
writings, however, certain emotional states appear as causal 
elements. In one case, a woman began to exhibit fears, 
depression, incoherent rambling speech, and the uttering of 
obscenities after suffering from a "grief with a reason for it"; 
and another "without speaking a word . . . would fumble, 
pluck, scratch, pick hairs, weep and then laugh, but . . . 
not speak," also "after a grief." 3 In The Sacred Disease, epilepsy 
is said in certain circumstances to be "caused by fear of 
the mysterious." 4 

Emotional factors played only a minor role in the 
subsequent development of classical medical thought because 
authors after Hippocrates continued to rely primarily on 
humoral-reductionism and did not actively pursue emotional 
causal elements. These medical authorities worked hard to 
clarify and codify the humoral ideas embedded in 
Hippocrates's work. They also systematized a therapy based 
on "opposition," whereby excess humors were depleted and 
"cold" medicines such as oil of roses countered "hot" dis- 
eases like fevers and vice versa. Some writers in late antiquity 
also added important anatomical features to their reductionist 
medical systems. 5 

But another dimension to medical thought became 
increasingly prominent in later antiquity. This was the orien- 
tation towards emotions as causes, which was strongly influ- 
enced by Galen (A.D. 131-201). Known for his prolific writ- 
ings and essential loyalty to humoralism, he was accepted in 
the medieval and Renaissance periods as coequal with or 
even superior to Hippocrates. Deeply respected for his diag- 
nostic skill, Galen was celebrated for his differential diag- 
noses, especially for those which distinguished between ill- 
nesses traceable to organic causes and those which seemed to 
mimic them but were actually traceable to emotional causes 

Justus Cortnummius (ca. 1624-1675), De Morbo 
Attonito Liber Unus, Leipzig, 1677 

For much of the medieval and Renaissance periods, 
Galen and Hippocrates were regarded as coequal 
medical authorities, with Galen even assuming a 
superior position for certain medical teachers or com- 
mentators. In the seventeenth century, however, the 
more empirically oriented Hippocrates came to be 
regarded as superior to the more theoretical Galen. 
This distinction between the two men is depicted here 
on the title page by Hippocrates touching the rose- 
bush on the side of the flowers and Galen touching 
the side of the thorns. 


Galen, Opera ex Sexta Juntarum Editione, Venice, 

Galen is making a diagnosis of love-sickness. 


. . . // came to t/u ' co/ic/usum tAat sA£y ohm rS/^erm^ro/^ on&oj 
/coo tAisups/: eitAer^/rom a /tte/a/tc/to/y c/efta/c/c/// on 6//f, 
e/vc trote/t/e a/tout so/?w//?//uj sAe cou& ce/tun/tina to co/ife&&. 


As quoted in Galen — On Mental Disorders, Stanley W. Jackson 

Maimonides (1 135-1204), Tractatus Rabbi Moysi de 
Regimine Sanitatis ad Soldanum Regem, 

Augsburg, 1518 

I ^^^^ 

Gregor Reisch |d. 1 525), Margarita Philosophica 
cum Additionibus Novis, Basel, 1517 

Gregor Reisch included an often-reproduced woodcut 
profile of the head in his book Margarita 
Philosophica. The figure locates various faculties of 
the soul {cogitation, memory, etc.) in specific regions. 
Note that Imagmativa (imagination) is located directly 
over the eyes. 

instead. In one famous case he treated a young woman who 
seemed to exhibit the signs of physical illness but who, upon 
closer examination, revealed no organic pathology. After elim- 
inating any possible humoral explanation, Galen identified 
the real, emotional cause of her somatic symptoms: a hidden 
love interest. 6 He used the sudden irregularity of her pulse as 
a crucial diagnostic clue. 

Galen likewise contributed an important new interest 
in the balance not only of the humors but of what he called 
the "non-naturals," among which he included the "passions 
or perturbations of the soul." 7 According to the doctrine of the 
non-naturals — which was incorporated in medieval medical 
books alongside the humors — it was important for physicians 
to help patients keep their emotions in balance, for the sake 
of their bodies as well as their mental states. The influence 
of strong emotions on physical health and illness thus became 
a central tenet of medical belief which grew progressively 
stronger in the medieval period. As rabbi, philosopher and 
physician Moses Maimonides expressed the point in the 
twelfth century, "It is known . . . that passions of the psyche 
produce changes in the body that are great, evident and mani- 
fest to all. On this account ... the movements of the psyche 
. . . should be kept in balance . . . and no other regimen 
should be given precedence." 8 

Ideas about the "balance of the passions" were popu- 
lar in the Renaissance and early modern periods. One famous 
work showing how influential these ideas would become is 
Robert Burton's The Anatomy of Melancholy which included the 
following observations about the possibly disastrous role of 
unchecked emotions: "the mind most effectually works upon 
the body, producing by his passions and perturbations miracu- 
lous alterations . . . cruel diseases and sometimes death 
itself." 9 Also in this period, speculation about the role of the 
"imagination" added other elements to the non-physical caus- 
es of disease. Some authors suggested that the imagination 
affected the body directly by its immaterial agency, others 
that it operated indirectly by first arousing the emotions 
which, in turn, "are greatly alterative with respect to the 


a //rivet//. 

Moses Maimonides (1135-1204) 

The Regimen of Health 

of A&ftycAe tAal 


Of cZMmfUrs and Tnd,g 

. 1517. in the parifh Kingf-wood, in the forrefl i 

1 ;u.) to die King's Engine* 

1 chat plat 
ho troubl 
. died,/! e 

, by ' u ■ in...,', J .lO.Ml.,. 
.-duiihhn l,i.J>..r,da,,dcoi 

e/Mmnm<d b> ttptimli ifitt mil 

tt t* E Eareconlffaincd 10 conlelt by the event of things, tint nionfterl art bred and 
gam caufledby the llraitneliofthewcaiib, lor foappltsKrovving upon the trees, if bc- 
SRE fore they comto juft ripcnetl, they bee put into llrali \tircls, their growth it hln- 
W*" deed. So Com whelps which women take delight In, are hindrrd from anle furthet 
? growrh bythelirUcntii of the place in which they arektpt W ho knows not that the plana 
n growing in the earth, ate hindred from a longer progrcls and propagation of fhtir roott,by 
theoppofitionofaant.orardeorhrtfolldbodie, and therefore in liich placet are ctaok- 
ed, flendee and weak, but on the other part, where they have fret nootlfhmtnt, to bee Unit 
and ilrorut ) for feeing tflJt by the opinion of Natural]!! I, the place is the form of the thing 
placed lie !• netefTarie that chofe thloR» that are Hut up lr 

nd lamed. 

o. P. 

: of the womb : which they thought ih. 

t fpacetjprohibltrd of fro 

nil births : The toogren 
privation ofgiowthbythc 
chielefl of all ibecaufthey 

? "'Kligr. 

'" "peciall, ,„ „ " ™™""°n : It la a 
otdef„™,°, ','"'"« 'hUdt, 

^^I'lKlvlth^hlfd'^'^ 1 "^ 1 - T h"elo,7they, hPr'' 1 ,t ™ ann eeofwale, r '"'y' l,,e 

J|Herei»nodoubtbutlfariJei„|„ r i, s. ' 

B fonof »firoke,rsl| fromvti Ll J «° "worn 

I estteod loth, child. TbVe^ Vi *" lik < 

B broker* ureflcd, On^tft?* efe occahon. ,„ 
ISO a^ "-ore , by the ilk, ,',„ °S of eh 1,'°™ " h " °>°"^ 
•^Tfiux o blond, oe great * * ^* »S < 

,Wie, by which nieanl the childe wanV-. „ Z y "•wurit coneuir 
S^„d altogether monllrouff ^'.U*cdWr,,, and thetefote ™ 

nwith childe, (_ 

o( »l opened or 
"ncultonof the 
will beetmall 

Ambroise Pare (151 0?-l 590J, The Workes, London, ! 649 

Speculation about the influence of the "imagination" was intense during the Renaissance period. It was widely believed that vivid ideas 
could lead to various bodily conseguences, including diseases and monstrous births. Pare, a famous early surgeon, reported on two 
cases, one of a child born with the body of a calf, and another that occurred in 1517, of a child "born having the face of a frog," pro- 
duced by the power of the mothers imagination. The mother, advised by her neighbor to hold a live frog in her hand as a means to 
cure her fever, was still holding the frog that evening, when she and her husband conceived a child. 

William Falconer (1744-1824), A Dissertation on 
the Influence of the Passions Upon the Disorders 
of the Body, London, 1 788 

body."" 1 There was general agreement that emotionally- 
charged ideas could exert enormous effects, as in the case of 
the monstrous "frog baby" produced by vivid maternal imagi- 
nation, reported by Pare. 

Intellectuals and lay people alike were strongly 
committed to these ideas in the seventeenth and eighteenth 
centuries. While certain philosophical fashions within the 
medical community changed to reflect the Scientific 
Revolution going on around it, much medical practice 
remained traditional and fundamentally unaltered. Consider- 
ation of the role of the imagination and of strong emotions in 
the onset and course of illnesses continued into the nine- 
teenth century. Medical literature included extensive essays 
and specialized monographs on emotional states and their 
impact on somatic health and disease." One example is 
William Falconer's A Dissertation on the Influence of the Passions 
{ 7 pon the Disorders of the Body. 

Bobonne, Bobonne, tu me ferais un mon- 
stre comme ca, ne le regarde pas tant!, 

Honore Daumier (1808-1879) 

The husband is attempting to lead his pregnant 
wife away from the cage of the great apes at the 
zoo. He is afraid that by looking at the ape in her 
condition, she might give birth to a deformed 
baby The longstanding belief that the vividly 
stimulated imagination of pregnant women 
could lead to "monstrous" births persisted in pop- 
ular culture well into the nineteenth century. 


In many ways, however, the close of the eighteenth 
century marked a new era. As part of the Scientific 
Revolution, anatomical investigation once undertaken in 
antiquity had revived and became a hotly pursued field of 
study. Andreas Ycsalius in sixteenth century Padua and 
Thomas W illis in seventeenth century Oxford were just two 
of the man\ bold explorers who cut into the body, probed its 
structure, and displayed their findings in beautifully illustrat- 
ed w orks. In the eighteenth century, physicians increasingly 
turned to anatomy as a foundation for pathology. As a result, 
disease processes were progressively "localized," that is, said 
to reside primarily in the disruptions or "lesions" of the solid 

eiufdcmq; charaftcrum Index. 

Illustration of dissecting instruments from Andreas Vesalius's De Humani 
Corporis Fabrica. The De Fabrica, the first modern work of anatomy, 
wasSly published in 1 543. This plate is from the 1 568 Venice edition. 

Andreas Vesalius 

Edouard Hamman 

What is particularly notable about this scene of Vesalius 
about to perform an autopsy is his gaze, directed away 
from the cadaver, and his hand resting on the left arm, 
almost as if taking a pulse. Like the Chartran portrayal of 
Laennec, this nineteenth century image strongly conveys 
the anatomical basis of the new medicine. 

Andreas Vesalius (1514-1564), De Humani Corporis 
Fabrica, Venice, 1 568 


Thomas Willis (1621-1675), The Remaining Medical 
Works of Thomas Willis, London, 1679 

An outstanding example of seventeenth-century anatomi- 
cal achievement was Thomas Willis's Cerebri Anatome 
(On the Anatomy of the Brain), first published in 
1 664. Shown here are Willis's engravings of the human 
brain (left page) and of the sheep brain (right page). 

parts of the body rather than in the imbalance of humors. 
Post mortem dissection became an increasingly common 
medical practice. 12 

At the turn of the nineteenth century, diagnostic 
breakthroughs swiftly succeeded the maturation of gross 
pathological anatomy. R.T.H. Laennec invented a primitive 
stethoscope (he called it a "cylinder") to help him hear inside 
his patient's body and thus imagine what the parts "looked" 
like because of the particular sounds they elicited. In the 
process of concentrating their attention on the anatomical 
abnormalities of the solid parts of the body during an illness 
and as a result of disease, Laennec and other physicians of his 
time gained precision in their diagnoses but began to lose 
the immediacy and intimacy of verbal contact with their 
patients. 13 Clearly captured in Chartran's painting of Laennec 
performing a physical examination is the growing communica- 
tion gap between doctor and patient, each seemingly con- 
tained in his own separate world. This stands in sharp con- 
trast to the scene typically depicted at the medieval bedside. 

The further development of microscopic anatomy by 
Rudolf Virchow and others in the nineteenth century led to 

Laennec-style Stethoscope 

In 1819, Laennec first described his powerful new diagnostic invention, the . 
cylinder-like stethoscope. The physician placed one end of the instrument on 
the patient's chest and his ear to the other, so he could listen to the sounds of 
disrupted anatomy within. 

Courtesy Historical Collections, The National Museum of Health and Medicine, Armed 
Forces Institute of Pathology, Washington, D C. 

Laennec, A I Hopital Necker, Ausculte Un Phtisique 

Theobald Chartran ( 1 849- 1 907) 

Rene Theophile Hyacinthe Laennec (1781-1826). De (Auscultation 
Mediate, ou, Traite du Diagnostic des Maladies des Poumons et 
du Coeur (On Mediate Auscultation, or. Treatise on the Diagnosis 
of the Diseases of the Lungs and Heart), Pans, 1819 

The stethoscope is illustrated here in a fold-out plate with parts of the 
lung shown at the right. 


Rudolph Virchow (1821-1902) is regarded as perhaps the greatest 
medical scientist of the nineteenth century. He was a pioneer in the field 
of cellular pathology and pursued pathological anatomy at the tissue and 
cell level. 


ZwiSlfte Vorlesung. 
Fig. 89. 

Rudolf Virchow, Die Cellularpathologie in ihrer 
Begriindung auf Physiologische und Pathologische 
Gewebelehre, Berlin, 1858 

In Virchows most influential book, Die Cellularpathologie, 

he described and depicted the precise microscopic structure 
of ceiis-jnciudmg nerve cells— but seemed to leave no 
place in the body's operation for the influence of the 

greater know ledge of tissues and cells. This development, 
unfortunately, also fragmented the notion of organismic unit} 
implicit in classical and early modern medical theory. 
Emotions became more and more separated from disease. 

By the mid-nineteenth century, however, a place was 
secured for emotions in connection with disease even as post- 
mortem anatomy and cellular pathology advanced. Already in 
the eighteenth century William Cullen had noted that 
patients with certain major disorders — "insanity," for exam- 
ple — did not always show the expected organic lesions upon 
postmortem dissection. He reasoned that, instead, such 
patients may have developed "a considerable and unusual 
excess in the excitement of the brain" and that this excite- 
ment could in turn have derived from "violent emotions or 
passions of the mind." 15 Cullen and Robert Whytt were two 

William Cullen (1710-1790), 
First Lines of the Practice of 
Physic, Edinburgh, 1 784 

cn ///a/?// instances <^ mumes persons,, tAeir^ b/Yun Acid been 
eaxzmcned 'after oteatAs, uutAaat sAmvin^t tAat any o/yxmio /esum& 
Aad /n/o/r subsisted in tAe 6 ram, orfodinp tAat ana mor6id 
steit&o/tAe vrum tAen affeeared. 

W illiam Cullen 

First L ines of the Practice of Physic, 1784 


of the many physicians who turned to the nervous system to 
find a physiological connection between emotions and dis- 
ease. These physicians hoped to find in nervous system phys- 
iology a compromise of sorts between traditional ideas linking 
emotions and disease and the new desire to extend the reach 
of localistic pathology. Since the nervous system was enor- 
mously complex and its functions were subtle and elusive, it 
couldbe the locus of "functional" disorders, which were char- 
acterized by disrupted activity but where no inflammation or 
"appreciable morbid change in the nervous structure" could 
be found. By the 1840s and 1850s, functional disorders of the 
nervous system (also called "neuroses") and the emotional 
causes that precipitated them had become a major area of 
clinical study, as is clear in Austin Flint's popular A Treatise on 
the Principles and Practice of Medicine. 

Austin Flint (1812-1886), A 
Treatise on the Principles and 
Practice of Medicine, 

Philadelphia, 1868 

. tA& neuroses /r//ui/o/ur/ c^ec//om\ . . . L 

occur a/so as s///u/)/outs pfc//se<rscs moo/w/yt either iu/tc 
or /cs/o//s of structure^. 

Austin Flint 

A Treatise on the Principles and Practice of Medicine, 1868 


Psychosomatic Medicine: 
"The Puzzling Leap" 

The next major stage in the unfolding of the relationship 
between emotions and disease began with the deeper explo- 
ration of one of the neuroses: hysteria. This complex disorder 
was long known in medicine but not until the seventeenth 
and eighteenth centuries was it seriously associated with the 
nervous system or emotional causation. Until that time it was 
regarded as of uterine origin, as its name implies (from the 
Greek "hystera" = uterus)." 1 In the seventeenth century, 
Thomas Willis thought that hysterical disorders were primari- 
ly convulsive consequences of "the brain and nervous stock 
being affected." Famous clinician Thomas Sydenham said 
that they were caused by "irregular motions of the animal 
spirits," which w ere frequently precipitated by "some great 
commotion of mind, occasioned by some sudden fit, either 
of anger, grief, terror or like passions." In the eighteenth cen- 
tury, Robert Whytt acknowledged that these disorders may 
mimic almost any common somatic condition in a "chame- 
leon"-like or "protean" fashion, and may be triggered by 
intense "imagination," as when a patient falls into convulsive 
fits upon seeing someone in an epileptic seizure. Because 
of the extraordinarily v aried nature of their symptoms and 
the suspected role of the emotions, patients suffering from 
hysteria and related "functional neuroses" were often thought 
by both physicians and lay people to be experiencing merely 
"imaginary diseases," as clearly depicted by the artist Honore 

In spite of this widespread attitude, by the 1840s and 
1850s hysteria was a serious subject in medical textbooks and 
in separate, often massively detailed studies. One of the most 
remarkable of these was the 800-page Traite Clinique et 
Therapeutique de FHysterie published in 1859 by Pierre Briquet, 
which presented data derived from 430 hysterical patients 
observed at a Paris hospital over a ten-year period. 17 Jean- 
Martin Charcot, the famous French clinician celebrated for 
his elucidation of organic neurological syndromes, also turned 
his attention to hysteria. In the 1870s, Charcot followed 
Briquet's lead in studying hundreds of hospital patients in an 
attempt to specify its precise symptomatology and 

clinical course.'" 

Charcot's goal was to discover regularity and pattern 
amidst the confusing welter of hysterical symptoms. He want- 
ed to show that despite its often dramatic appearances, hyste- 
ria was not merely "protean" but a solid clinical entity with 
recurrent and universal features, just like the anatomically- 
based neuropathological conditions he had previously stud- 
ied With the help of meticulous, long-term observation and 
the innovative use of the photographic camera, Charcot deter- 

Le malade jmaginaire 

Honore Daumier (1808-1879) 

Even as some doctors defended the idea of "neu- 
roses—nervous diseases without apparent organic 
cause— others remained suspicious. Weren't neurotic 
disorders better thought of as the imaginary diseases 
of tiresome patients looking for attention? 

Courtesy Penny Herscovitch 


Camera, ca. 1 900 

People said that the camera was as crucial to Charcots objective study of hysteria as the microscope was to histology 
Courtesy Historical Collections, The National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, D.C. 

Planche II. 

Planobe XXXIX. 

ATTAQUE HYSTERO-EPILEPTIQUE lethargie Bourneville and Paul Regnard, Iconographie Photographique de la Salpetriere, Pans, 1877-1880 

At the Salpetriere. doctors photographed and catalogued the supposed organic markers of hyster.a. Charcot that the resulrinn 
record of symptoms was "valid for all countries, all times, all races." and "consequently universal." resulting 






Josef Breuer and Sigmund Freud, Studies on Hysteria, New York, 


Studies on Hysteria included the famous case study of "Anna O." 

Sigmund Freud 

Sidney Chafetz 

QBal obsessional 'neuro&i&> in, asAieA tAie feu&zAng leafijrom 
tAe menial txr tAe />A^tixil ft/ays no^art, A as actaa/A/, 
t/traagA tA&eforts offiiycAcr-aruufyAM, ^ecam& m^/^ ^er^Hawm 
cwffarni/iar to a& tAuuv Ae/^steria, and am Aave Aeamt tAat 
a dis/dcu/& certain, extreme characteristics- of tA& nature of 
nearos/sfar /ruyf^/arin^^. 

Sigmund Freud 

The Standard Edition of the Complete Psychological Works 
of Sigmund Freud, 1916-1917 

Thomas W. Salmon. The Care and Treatment of 
Mental Diseases and War Neuroses ("Shell 
Shock") in the British Army, War Work Committee 
of the National Committee for Mental Hygiene. New 
York. 1917 

Courtesy National Mental Health Association 

mined and extensively depicted several characteristic and 
general phases of the hysterical disorder. He insisted that 
"nothing occurs at random but, on the contrary, all follows 
certain well-determined rules which are common to cases 
seen in both hospital and priv ate practice."'" Later Charcot 
introduced hypnotism as both an experimental and therapeu- 
tic technique to explore other strange phenomena manifested 
by hysterical patients and also as a potential key to unlocking 
the underlying neurophysiological and possibly psychogenic, 
trauma-related mechanisms of the hysterical neurosis. : " 

Young Sigmund Freud studied with Charcot in Paris 
during the w inter of 1885-1886 and was deeply impressed by 
his ideas. Freud had already been alerted to the bizarre phe- 
nomena of hysteria and to the linkages with hypnosis by the 
Viennese physician Josef Breuer. Breuer had told Freud about 
a patient ("Anna ().") whose strange hysterical symptoms he 
treated in 1880-1882 by inducing hypnotic states and system- 
atically leading her back to the onset of each symptom. Once 
the patient re-experienced the original circumstances with a 
display of emotion, the corresponding hysterical symptom 
disappeared. Freud's study w ith Charcot gave him a theoreti- 
cal framework to understand what Breuer had told him. 
W hen he returned to Vienna, he and Breuer began a close 
collaboration publishing their joint Studies on Hysteria in 1895. 
They hypothesized that hysterical symptoms derive from 
undischarged "memories" connected to "psychical traumas." 
These memories originated when the nervous system was in 
a special physiological condition or "hypnoid state"; they 
then remained cut off from consciousness. Hysterical symp- 
toms resulted from the "intrusion of this second state into the 
somatic innervation," a mind-to-body process Freud and 
Breuer called "conversion." 

Tensions and differences steadily separated Freud 
from Breuer. Breuer pursued physiological hypotheses and 
the continued use of hypnotic techniques. Freud moved in 
the direction of psychological mechanisms and the abandon- 
ment of hypnosis. As Freud's ideas further matured, he dev el- 
oped a novel set of theories and techniques that he called 
"psychoanalysis." He introduced revolutionary theoretical 
concepts such as "unconscious" mental states and their ener- 
getic "repression," the widespread occurrence of infantile 
sexuality, and the symbolic encoding of psychological mean- 
ing in dreams and hysterical symptoms. Freud also stressed 
the investigative techniques of "free association" and dream 
interpretation, two methods for overcoming "resistance" and 
uncovering hidden unconscious w ishes without using hypno- 
sis. He thus shifted away from Charcot's observational 
approach to an even more revolutionary one: he substituted 
listening to patients for looking at them. 

The strong psychogenetic explanation of hysterical 
symptoms remained a key feature of Freud's mature work 
and of later psychoanalysis. In his Introductory Lectures of 


1916-1917, he promoted the notion of conversion as a "puz- 
zling leap from the mental to the physical" and continued to 
describe hysterical symptoms as symbolic representations of 
unconscious emotional conflicts. During World War I, Freud's 
ideas about the emotional origins of hysterical symptoms 
were often applied to shell-shock and other u war neuroses." 
Soldiers displaying such somatic symptoms as paralysis, mus- 
cular contracture, and loss of sight, speech, and hearing for 
which no organic bases could be found came to be regarded, 
as in Thomas Salmon's book, as suffering from conversion 
hysteria. 21 In these cases, psychogenic explanation focused on 
unconscious conflicts between "fear" and "duty" with a 
resulting "flight into illness." 

In the 1920s and 1930s conversion hysteria gained 
popularity as a general medical notion, as psychoanalysts 
joined internists and other physicians in exploring the mean- 
ing of hysterical symptoms. Particularly influential were the 
Austrian Felix Deutsch, the American Smith Ely Jelliffe, and, 
most provocatively, the German Georg Groddeck, all physi- 
cians and pioneer psychoanalysts." Groddeck was a forceful 
proponent of the view that the psychological mechanism for 
hvsterical conversion could be generalized to the entire range 
of somatic diseased He argued in The Book of the It that symp- 
toms in any organic disorder could be interpreted like hysteri- 
cal symptoms, as symbolic expressions of unconscious wishes 
manifested in the patient's body. 

The emigre psychoanalyst Franz Alexander tried to 
work out a compromise between physiology and Freudian 
theory.' 4 Soon after his arrival in the United States from 
Europe in the early 1930s, he repudiated the approach taken 
by Groddeck and like-minded analysts. He carefully distin- 
guished between classic conversion hysteria and what he 
called "organ neuroses," those disturbances of organic func- 
tion controlled physiologically by the autonomic nervous sys- 
tem (where unconscious symbolic processes are not present). 
According to Alexander, Groddeck and others had erased a 
boundary that needed to be carefully redrawn. They had 
interpreted everything too psychologically and had ignored 
the automatic physiological mechanisms that substantially 
controlled the expression of emotion as the body responded 
to stressful stimuli. But still faithful to the psychoanalytic tra- 
dition, Alexander also identified specific unconscious wishes 
and infantile desires (for example, the unconscious wish to be 
fed) in the "psychic stimuli" that he said precipitated specific 
chains of physiological response and, ultimately, specific- 
somatic diseases. 

Alexander's theoretical formulations helped stimulate 
serious psychosomatic research in the United States. He orga- 
nized a group of investigators from various clinical and labora- 
tory disciplines at the Chicago Institute of Psychoanalysis, 
and additional research groups soon developed elsewhere 
Prominent among these groups was one led by Stanley Cobb 


Georg Groddeck 
New York, 1928 

934), The Book of the It, 

Groddecks Book of the It— that helped inspire 
Freuds own concept of the "id"— claimed that all phys- 
ical illnesses are produced by the unconscious mind. 


Flanders Dunbar 

Psychosomatic Medicine, September-October 1 959 

Helen Flanders Dunbar (1902-1959). A Dante scholar, 
theologian and medical doctor, Dunbar hoped psycho- 
somatic medicine would integrate the treatment of 
spiritual, emotional and physical suffering into a single 

Used with permission from Williams & Wilkins 

Helen Flanders Dunbar, Emotions and Bodily 
Changes: A Survey of Literature on 
Psychosomatic Interrelationships, 1910-1933, 

New York, 1935 

at the Massachusetts General Hospital. In addition. Helen 
Flanders Dunbar at the Columbia Presbyterian Medical 
Center in New York City produced a pioneering monograph. 
Emotions and Bodily Changes: .1 Survey of Literature on 
Psychosomatic Interrelationships, 1910-1933, winch synthesized 
recent research findings and in its subtitle gave the growing 
American movement a name. In 1939, Psychosomatic Median, 
was founded as the first medical journal devoted specifically 
to publishing research in this expanding area of investigation. 

World War II accelerated the growth of psychosomat- 
ic medicine even further. As in World War [, many soldiers 
displayed the symptoms of shell-shock and its debilitating 
variants, but during this war the American Armed Forces 
mobilized psychiatrists and others trained in psychosomatic 
medicine to help with the problem. 26 Roy R. Grinker's and 
John R Spiegel's War Neuroses in North Africa: The Tunisian 
Campaign (January-May, 1943) is an indication of wartime 
concerns; their expanded edition, Men Under Stress, con- 

Roy Grinker and John P Spiegel, 
War Neuroses in North Africa: 
The Tunisian Campaign 
(January-May, 1943). 

Prepared and distributed for the 
Air Surgeon, Army Air Forces by 
the Josiah Macy Jr. Foundation, 
New York, September, 1943. 

Used with permission from Josiah 
Macy, Jr. Foundation 

Used with permission from Josiah Macy. Jr Foundation 

Roy R. Grinker and John R Spiegel. Men Under Stress, 

Philadelphia. 1945 


tributed to the heightened postwar enthusiasm for psychoso- 
matic medicine, as did the famous director John Huston's film 
for the Armed Forces about combat veterans recovering from 
psychosomatic disorders. Let There Be Light. Interest in psy- 
chosomatic medicine in the late 1940s and in the 1950s 
became so intense, in fact, that the scientific literature multi- 
plied rapidly, medical schools created new instructional pro- 
grams, and textbooks such as Edward Weiss's and Spurgeon 
English's Psychosomatic Medicine found an eager audience 
among a whole generation of medical students. In addition, 
Franz Alexander supplemented his numerous professional 
writings with a popular general text that was as widely read in 
non-medical as in medical circles and as influential through 
its diagrams as through its accessible prose. Psychosomatic 
medicine was so much the "rage" at mid-century that popular 
magazines ran articles by the score and psychosomatic theo- 
ries even found their way into the lyrics of a popular 
Broadway show. 

Figure III. 

Schematic representation of specificity in the etiology of peptic ulcer 


Franz Alexander, Psychosomatic Medicine, New York. 1 950 
Used with permission from WW Norton and Company, Inc. 


Self-Healing, Patents, 
and Placebos 

I lowever fashionable psychosomatic medicine became, it was 
by no means the only way Americans pursued their interest in 
the relationship between emotions and disease. A long-stand- 
ing tradition of mental self-help, not directed by physicians 
and concentrating on overt and positive rather than covert 
and negative feelings, began in the late nineteenth century 
and was still strong in the 1950s and 1960s. This tradition had 
consistently focused attention on proactive ways people could 
become more positive and optimistic about life, master their 
moods, and fix their physical ills without taking medications. 
People could align their thoughts and constructively adjust 
their attitudes. Because mind and body were assumed to be 
closely interconnected — as physician and Declaration-of- 
Independence-signer Benjamin Rush had clearly indicated in 
1811 — it was taken for granted that harmonizing one's emo- 
tions in a positive way would, unquestionably, improve one's 
physical well-being. 


A scale of the progress oj Temperance and Intemperance.— Liquors with effects in their usual order. 


Health and Wealth. 

Water, ) 

(Serenity of Mi 

nd, RepulatioD, Long Life, and Happiocas. 

Cheerfoloeat, Strength, and Nourishment, when taken only m iraall quanti" 
ties, aDd atmeala, 



Fighting, Hone ] 

Lying and Sweari 

Stealing and Bwi 

Si ~ ■ VFi The some morning and er CT ,nr.J?orglarr» 

■-^t-n The same daring day and my/T^-Murder, 


ose an.lBlaek F.yes, 
and liag.. 

Dropsy, Epilepsy, 

\felwicholy, palsy, apoplexy, 
Madness, Despair, 

Hnjpital r 
Poor Ho 


„\o. fo. Life, 


Benjamin Rush (1746-1813), An Inquiry 
into the Effects of Ardent Spirits upon 
the Human Body and Mind, with an 
Account of the Means of Preventing and 
of the Remedies for Curing Them, 
New York, 1811 

In the United States, efforts to articulate the 
relationship between the care of the body 
and the state of the mind, morals and 
emotions date back almost 200 years. 


Julia Anderson Root, Healing Power of Mind: A 
Treatise on Mind-Cure, with Original Views on 
the Subject and Complete Instructions for 
Practice and Self-Treatment, Peoria, Illinois, 1 886 

This American sclf-hdp tradition fust developed in 
New England, where it was tied in with a variety of philo- 
sophical and religious currents.- 7 It spread quickly to other 
parts of the country, as evidenced by Julia Anderson Root's 
Healing Power of Mind '(first published in San Francisco in 
1884) and Albert Vernon's Correspondence Course of Instruction 
in the Science of Psychratism. Medically-trained Harvard psy- 
chologist and philosopher William James took an active and 
supportive interest in what he called "The Religion of 
Healthy-Mindedness" which, he reported in 1902, "has 
recently poured over America and seems to be gathering force 
every day." 2 * James claimed that "mind-cure gives to some of 
us serenity, moral poise, and happiness, and prevents certain 
forms of disease as well as science does, or even better in a 
certain class of persons." 29 Even physicians who worried about 
the excesses of the mind cure movement were forced to 
admit that cures of functional disorders often followed mind 
cure practice and that "physicians have failed for many years 
to pay sufficient attention to what may be aptly called psychi- 
cal disorders of the body, or psychical conditions engendering 
functional derangements, or functional disturbances produced 
by psychical states."' A great concern of many turn-of-centu- 
ry medical practitioners, however, was that people with seri- 
ous illnesses might never get to see a properly trained physi- 
cian because they were so intent on curing themselves via 
mental self-adjustment. 

6und Aiaae Aeem made to &e& } /Ac 
Aia/t to cou/A/; /fdaaa ///ocd/d? Aaoc A ad 
tAc/r Aca/tA restored. . . . On&Aear^ a 
/Ac ' \ Ocm/jc/ 'pfdie/aczxrt/o// "of /Ac 
"Won 7 c ff h/vy, Movement, " ofjbeoft/& 
coAo repeat ta /Ac//^c/oos\ "9/outA, 
Acer //A, amor/". . . 

William James 

The Varieties of Religious Experience, 

William James 

Notman (photographer) 

Despite professional anxiety and disapproval, self- 
healing continued to spread in the twentieth century. John 
Kearslev Mitchells Self Help for Nervous Women and Charles 
Fremont Winbigler's How to Heal and Help One's Self are just 
two examples of the literally hundreds of books, manuals, and 
magazines that were published in the early decades. Emile 
Cone's technique of "autosuggestion," according to which 
patients affirmed to their own image in a mirror that "Day by 
day in every way, I am getting better and better," was just 
another, mildly hypnotic self-healing ritual which became a 
national fad in the early 1920s." The creation of Alcoholics 
Anonymous in the thirties as a network of self-help groups 
drew from these same sources. i: By the 1940s the self-help 
movement took on an increasingly secular, more psychologi- 
cal and less religious tone." Dale Carnegie's How to Stop 
Worrying and Start Living, Norman Vincent Peale's The Power 
of Positive Thinking, and Thomas Harris's /'/// OK — You're OK 
were later representatives of the genre, as was the "Laughter 
is the Best Medicine" feature in Readers Digest. The emphasis 
on the positive role of upbeat emotions has been continued 
recently in Norman Cousins's many books and articles, even 
though Cousins rested his self-help advice more heavily on 
medical authority than did most of his predecessors. 34 

Focus on the salutary effect of optimism had another 
important consequence for medicine: it put long-standing 
popular enthusiasm for "cures," "remedies," devices, and so- 
called "patent medicines" in a new perspective. At the turn 
of this century, organized medicine fought a pitched battle 
with those purveyors of hope one historian has called the 
"Medical Messiahs" — and generally won, at least in the sense 
that in 1906 Congress endorsed the American Medical 
Association's campaign and passed the Pure Food and Drug 
Act, which banned false and fraudulent advertising and 
labelling practices. 35 The AMA was even more effective in 
curbing the commercial drug market by creating its own 
regulatory mechanisms for product testing and surveillance 
and by putting pressure on newspapers and magazines to 
refuse lucrative advertising revenues. i " But astute physicians 
realized that well into the twentieth century, people contin- 
ued to purchase extraordinary quantities of worthless nos- 
trums— "Boyd's Batteries" and even "powdered unicorn's 
horn"— not merely because they were gullibly manipulated 
by quacks and cheats but because people believed that at 
least a few of these products, in some sense, really "worked." 
Patients often felt better after following a commercially pur- 
veyed regimen or swallowing a mass manufactured tonic. 
In certain cases they actually did get better. "Mental medi- 
cine" of some sort, the physicians assumed, was operating 
behind the scenes. 

Many times before, physicians had confronted the 
phenomenon of misplaced public trust validated by apparent- 
ly successful cures. One of the more notable episodes 

Norman Vincent Peale (1889-1994), The Power of 
Positive Thinking, New York, 1992, ©1952 

Reproduced with permission of Random House 

Thomas A. Harris ( 1 9 1 3- ) 
New York, 1973, ©1967 
By permission of Avon Books 

I'm OK— You re OK, 

"Laughter is the Best Medicine," Reader's Digest, 

April 1958 

By the middle of the century, even such mainstream 
journals as Reader's Digest had absorbed the mes- 
sage that positive emotions were "good medicine." 

Courtesy Ghilta Sternberg. Used with permission from Readers 




Fevers. Congestions Inflammations 25 

Worms. Woinrever Worm Colic 25 

Teething Colic.Ccying Sleipl(s:ness 25 

Diarrhea ol Children or Adtllls 25 

Dvsentervcnpinf.BiiioutCok 25 

Cholera Morbus, vommng 25 

Coughs ; ' b •-<•■:.- 25 

Neuralgia Tooimcv raceacne 25 

Heauacnes Sic«H>*iacht.vtriigi 25 

Dvspepsia Indic/slmiWealcSljmacn 25 

Suppressed Menses and Scanty 25 

leucorrhea or Profuse Menses 25 

C roup Hoarseness laryngitis 
CCZema Erysipelas, truplions 

Rheumatism mt Rheumatic MM 

Malaria CMU lever and Ague 

Pars or Hemorrhoids 
Ophthalmia or Sore Eyes. 


Catarrh.lnilueiKa ColdinHead 25 

Whooping C0llgll.5pasmtidi; Cough 25 

Asthma. Oppressed Breathing 25 

Ear Discharges. Earache. 25 

Enlarged Glands and Swellings 25 

General Debility. Physical Weakness 25 

OrOtSy and Scanty Secretions 25 

Nausea. Vomiting Sea Sickness 25 

Kidney Diseases 25 
Nervuus Prostration 1 00 

Sore Mouth. Cankpr.Fever Sores. 25 
Urinary Weakness wtmng n* eed 25 
Painful Menses. 25 
Disorders ri *,'Heari PiiiitatM 1 00 

Spasms and Convulsions 100 

ISoreThroal rjuinsyUiceraiedihrcit 25 

1 Chronic Congestions am tmttms 25 
Grip La Grippe Grippe 25 


"THE PILE OINTMENT 25 and 50 Cents 

Perkins's Metallic Tractors 

Courtesy Historical Collections. The National Museum of Health and Medicine, Armed 
Forces Institute of Pathology. Washington, D.C. 




Benjamin Douglas Perkins (1774-1810), The Family 
Remedy; or, Perkins's Patent Metallic Tractors, 
For the Relief of Topical Diseases of the Human 
Body; and of Horses, London, 1 800 

John Haygarth, Of the Imagination, as a Cause and as a Cure 
of Disorders of the Body; Exemplified by Fictitious Tractors, 
and Epidemical Convulsions, Bath, 1 800 

Four Batteries 

Perkins's Metallic Tractors may have been exposed as fraudulent, but the public 
has repeatedly resisted the cautions of the medical establishment and contin- 
ued over the years to "discover" the therapeutic power of similar kinds of 
objects. In this century, "Boyd's Batteries" and similar objects were worn around 
the neck to improve flagging energy and soothe various aches and pains. 

Courtesy Elaine and Arthur Shapiro 

involved a patented device called "Perkins's Metallic 
Tractors." These little pins were advertised as curative tor 
"topical diseases" from gout to rheumatism. Many discerning 
people, including George Washington, testified that the true- 
tors worked. Dr. John Haygarth attempted to expose the 
fraud (he found that wooden pins worked as well as the 
allegedly metallic ones that were supposed to channel the 
body's "galvanic" electricity) in a tract entitled Of the 
Imagination, as a Cause and as a Cure of Disorders of the Body; 
Exemplified by Fictitious Tractors, and Epidemical Convulsions. 
I laygarth's attempt to discredit a popular fad by highlighting 
the therapeutic role of aroused imagination was repeated by 
other medical authors, perhaps most impressively in the 
widely read Illustrations of the Influence of the Mind Upon the 
Body In Health and Disease, Designed to Elucidate the Action of the 
Imagination, written by the respected British psychiatrist 
Daniel Hack Tuke. Tuke exhaustively documented the 
Perkins episode but concluded with a critique of the medical 
profession. Those physicians like Haygarth who debunked 
Perkins by pointing triumphantly to the role of the "imagina- 
tion" and then dropping the issue without seeming to care 
whether or not patients actually improved, displayed a behav- 
ior that struck Tuke "as astonishing as that the public should 
believe in, and allow themselves to be cured by, the metallic 
tractors."" By 1900 a sizeable group of American physicians 
regularly invoked Tuke as a weighty authority as they battled 
against both public credulity and seeming professional indif- 
ference to "mental medicine." 

The issue was quite complicated and compromised 
for physicians. Many of them were aware that they too pre- 
scribed medications whose principal basis of action was the 

^ tA&/zpAt usAuA toe Aaoe to coaa& 
o/cwo////// apain&t /'(///o ranee; and 
(/aac/u '/ vy a// tony ///ey mewj^ andfoSex 
ofa/l sorts among, tAe c/awos\ a/ayn&- 
-r/.'v, not (/racfc/ou/, c& oar c/o'(f ayeetftvn 

William Osier 

Aequanimitas, "Chauvinism in 
Medicine," 1904 


patient's credulous belief. The term "placebo" was long used 
in medicine for a prescribed substance thought to be medical- 
ly inert but helpful for cajoling or controlling "neurotic" 
patients bv giving them something in which to believe and by 
which they might be "cured." s The most experienced and 
sophisticated physicians knew that many medicines thought 
to be effective were really not, at least not on the basis of 
pharmacological principles. The regular profession was itself 
often guilty of "over-drugging." Thus William Osier, the 
beloved and influential turn-of-century professor of medicine 
at Johns Hopkins University, could slap dow n quacks and jab 
at his colleagues at the same time by saving, "In the fight 
w Inch we have to w age incessantly against ignorance and 
quackery . . . diagnosis, not drugging, is our chief weapon of 
offense." Some went even further. Lewellys F. Barker, Osier's 
successor as professor of medicine at Hopkins, suggested that 
whatever success modern physicians had with their pre- 
scribed medications depended largely on their ability to 
"awaken confidence and inspire the idea of authority by their 
scientific training and by their mode of inquiry and of exam- 
ining the patient." ' Even more provocatively, Harvard profes- 
sor of psychiatry C. Macfie Campbell declared in a much 
noted 1924 lecture that physicians sometimes brought about 
the improvement of their patient "unw ittingly, when the 
patient is already prepared for the display of power." "It is 
well to realize," he cautioned, that the patient "who comes 
from afar to a great medicine-man with these wonderful 
machines, w hich extract wisdom from the air, is already half- 
way on the road to recovery." 4 

Thus the groundwork was laid for the serious investi- 
gation of the role of hope, imagination and expectation in the 
operation of medications and procedures in scientific medi- 
cine. W.R. Houston defined the issue clearly in a 1937 
address to the American College of Physicians when he said, 
"The great lesson ... of medical history is that the placebo 
has always been the norm of medical practice." 41 Eugene F. 
DuBois, professor of medicine at Cornell University, 

9/ou cannot torite ayfraurfit^ antAout tA& e/emmt of 
Q />/ocdo. . I /tracer to ffftu^ sto/ts ^//^^^. St carrie&- 
w {9 /?t, t/ie «>«(//</ of /too or t/o+ee domans/j/m/v ofm^iw. 

Eugene F. DuBois 

"The Use of Placebos in Therapy," Cornell Conferences 
on Therapy, 1946 


expressed similar sentiments in 1946. By this time drug 
companies w ere marketing code-named placebos for use in 
clinical practice. Soon afterwards, scientists conducted experi- 
ments on placebo effects. This coincided, not accidentally, 
with the period w hen the pharmaceutical industry was pro- 
ducing penicillin and other "wonder" drugs whose full power 
and range of action had not yet been tested and when 
psychosomatics had become a central concern of mainstream 
medicine. 1 ' Rigorous studies, often measuring placebo effects 
in experimental drug trials, multiplied rapidly, more being 
published in the four years from 1954 to 1957 than in all prior 

Placebos were produced for clinical use in a range of different shapes and colors and 
physicians even discussed which colors and shapes worked best. Bottles were labeled with 
simple code names fCebocap, Obecalp) so patients would not catch on to the fact that 
they were being given a placebo rather than a real drug. 

Milk sugar (or lactose) was the classic placebo that physic.ans sometimes used in their 
b ° tt,e ° f SU9ar P ' aCebOS = Pr ° dUCed f ° r «S S Merck 

Courtesy Elaine and Arthur Shapiro 


years combined. In 1955 one of the leading young investiga- 
tors, Louis Lasagna, was invited to write about placebos in 
Scientific American, a clear sign that the field had "arrived." 43 
Serious work on placebos continued over the next 
two decades. ln\ estimators pursued many fruitful lines of 
research, but two of the most productive turned out to be the 
exploration of psychological mechanisms in experimental 
subjects identified as "placebo reactors" 44 and the specifica- 
tion of the brain biochemistry which underlay placebo 
effects. 45 In one of the most suggestive studies in this second 
line of research, published in The Lancet, Levine, Gordon, 
and Fields concluded that the activity of "endogenous 
opioids"(the body's own opium-like substances) accounts for 
"placebo analgesia." Although there are many unanswered 
questions, by the late 1970s it appeared as if both clinicians 
and basic scientists had accepted the placebo effect as a 
central phenomenon in medicine — indeed, as one of the 
body's arsenal of self-protective weapons — and thought it 
ultimately explicable in the most modern biochemical terms. 

Jon D. Levine, Newton C. Gordon and Howard L. 
Fields, 'The Mechanism of Placebo Analgesia," The 
Lancet, September 23, 1 978 

©1978 by The Lancet Ltd. 

By the ,950s. researchers began to use 

and others dummy drugs that looked ,dent,cal-and the n compared the th ^P^ ,c psycho | g,car effect of its placebo, 
bo effect in its own right, but to sort out the real effec of an ac ,ve drug from he y p y ^ y ^ 
Pharmaceutical companies produced these placebos in the 1 960s for use in testing a a y 
Courtesy Elaine and Arthur Shapiro 


Stress and Deprivation 

During the same few decades which saw great advances in 
the understanding of placebos, psychosomatic medicine also 
underwent significant changes, both in the research and clini- 
cal field and in the wider area of popular interest. The most 
important changes centered on the virtual abandonment of 
ideas about the role of unconscious emotions, early childhood 
experiences, and personality peculiarities — all derived from 
psychoanalysis. These ideas were replaced by a focus on 
manifest emotions, current life situations, and the socio- 
environmental circumstances in which disease occurred. 4 '' 
Scientists often stated the newer formulations in terms of 
maladaptation and loss or, more commonly, "stress" and 
"deprivation." Researchers drew from physiological theory 
and experiment and extended their concepts to all diseases, 
not just the classic "psychosomatic seven" (which included 
peptic ulcer, asthma, hypertension and, depending on the 
psychosomatic texts, colitis, cardiac arrhythmia, neuroder- 
matitis, and hyperthyroidism). Yet at the same time that sci- 
entists broadened the range of emotion-disease connections, 
the once almost unquestioned presumption of psychogenic 
etiology for the "psychosomatic" diseases gave way to an 
increasingly somatic orientation. In the realm of therapy and 
disease management, individual psychotherapy was replaced 
by stress reduction, structured mobilization against feelings of 
loss and loneliness, and increased reliance on the therapeutic 
options of biomedicine. 

The decline in the medical popularity of psycho- 
analysis, evident in the late 1950s and continuing in the 1960s 
and 1970s, set many of these changes in motion/ 7 Leading 
researchers submitted analytically-based theories of peptic 
ulcer, asthma and ulcerative colitis to searching criticism and 
substantial revision. Therapeutic approaches relied more and 
more on new drugs and medical interventions and less and 
less on psychodynamic psychotherapy. 48 In the most dramatic 
case, scientists have recently attributed the cause of peptic 
ulcer to a spiral bacterium, best managed clinically with 
antibiotics. This new movement even attacked conversion 
hysteria — one of the major contributions of Freud and a 
mainstay of psychosomatic theory. Several important critics 
started picking at the loose and unreflective consensus that 
had come to surround symbolically interpreted hysteria. One 
of the most influential critics, the respected neurologist Eliot 
Slater, in a widely noted paper published in 1965, called the 
diagnosis of conversion hysteria "a disguise for ignorance and 
a fertile source of clinical error." 4 '' 

This discrediting of psychoanalysis created a widen- 
ing gap in psychosomatic thought that was steadily filled by a 
variety of theoretical alternatives. These concepts rested on 
more directly observable and less arcane linkages between 


Walter Bradford Cannon (1871-1945). Bodily Changes 
in Pain, Hunger, Fear and Rage: An Account of 
Recent Researches into the Functions of 
Emotional Excitement, New York, 1915 

Reproduced with permission from Appleton and Lange 

, JaupAt to c/ca/ coitA concrete and 
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are lie/// to minimize or neglect 
tA^aT^aem^o/ a/f emotional v/we/ 
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Walter B. Cannon 
The Role of Emotion in 
Disease, 1936 

emotions and the onset of disease. However much these the- 
oretical alternatives differed, they had in common a psychobi- 
ological orientation, in the sense that they were clearly based 
on notions of holistic body and mind response of the total 
human organism to various stimuli, threats and assaults from 
its environment. A common origin explained the similar ori- 
entation of these new theoretical approaches, for they all 
derived in some sense from the fundamental work of early 
twentieth-century Harvard physiologist Walter B. Cannon. 
Cannon's general program was to show how the biological 
organism automatically mobilized its physiological and bio- 
chemical resources by a built-in "wisdom of the body," to 
defend itself against real or threatened assault. As an example 
of defensive mobilization, he explained in Bodily Changes 
in Pain, Hunger, Fear and Rage, the organism responds to fear 
and rage as though preparing for fight or flight, by shutting 
down energy-storing functions and activating energy-releasing 
ones. In the 1940s, psychosomatic investigator Harold G. 


Wolff and his associates at Cornell Medical School incorporat- 
ed many of Cannon's ideas."' Wolff then moved from a model 
of organismic self-defense directly borrowed from Cannon to 
a generalized notion of "stress and disease," according to 
w hich disease w as the "inept" version of a normally "apt pro- 
tective reaction pattern" that allowed the human organism to 
mobilize against stressful situations or events. 51 

Stress became a leading new idea in psychosomatic 
theory in the 1950s and Hans Selye emerged as its best 
known and most effective proponent. Selye was a Vienna- 
born, Prague-trained physician and biochemist who settled in 
Montreal in the 1930s and w rote the leading endocrinology 
textbook in 1947. In 1950 he published a 1,025-page mono- 
graph entitled The Physiology and Pathology of Exposure to Stress, 
in which he elaborated ideas he had been developing since 
1936 on what he called the "General Adaptation Syndrome." 52 
Selye's theory was that various "stressors" (cold, heat, solar 
radiation, burns, "nervous stimuli") produce a generalized, 
stereotyped response in the biological organism as it works to 
"perform certain adaptive functions and then to reestablish 
normalcy." As the organism automatically mobilizes its 
defense mechanisms, the hypothalamus (a nerve center at the 
base of the brain) is excited first. Later, after a chain of 
effects, the adrenal glands produce "corticoid" hormones. 
Corticoid hormones cause a characteristic set of somatic reac- 
tions including the development of gastrointestinal ulcers. 

Due largely to their synthetic scope, Selye's ideas 
swept the field and exerted an enormous influence. As F.L. 
Engel noted in 1956, "[Selye's theory of stress and the dis- 
eases of adaptation] has permeated medical thinking and 
influenced medical research in every land, probably more 
rapidly and more intensely than any other theory of disease 
ever proposed."" The "stress syndrome" became even more 
popular and widely known in the sixties, partly because of its 
appeal as a replacement for older, increasingly discredited 
psychoanalvtically-based psychosomatic theories and partly 
due to Selye's charisma and prodigious output. He published 
forty books and over 1,700 scientific papers in the course of 
his career ^ 4 Selye was frequently quoted throughout medi- 
cine, nursing, and other health fields, and his fame spread to 
the wider culture, a reputation he deliberately cultivated by 
publishing such books for the general reader as The Story of the 
Adaptive Syndrome (1952), The Stress of Life (1956 and 1976), 
and Stress Without Distress (1974). Yet by the 1970s there was 
discord in the field of stress research as Selye conceived it. 
Growing confusion and controversy riddled theory and exper- 
iment. Some critics blamed Selye for having caused a great 
deal of it with his conceptual inconsistences and his shitting 
and sometimes contradictory formulations." 

One major alternative challenged the stress model 
during the height of its initial popularity. George Engel and 
his ^leagues at the University of Rochester Medical Center 


Hans Selye, The Physiology and Pathology of 
Exposure to Stress, Montreal, 1 950 

Readers Digest, February 1957 

Courtesy Ghilta Sternberg. Reproduced with permission 
Readers Digest 

American Journal of Nursing, March 1965 
Used with permission of Lippincott-Raven Publishers 

developed a theory they ultimately called "conservation-with- 
drawal." Like Selye, Engel and his associates focused on psy- 
chobiological threats to an individual's well-being. But instead 
of considering threats as "stressors" that elicited defensive 
and protective behaviors from the hyperaroused organism, the 
Rochester group conceptualized the most important of these 
behaviors in terms of "losses" and "deprivations" that caused 
the organism to become withdrawn, depressed and shut- 
down n. 56 The Rochester group was generally attuned to psy- 
choanalytic theory and remained committed to preserving a 
place for it even in post-Alexandrian psychosomatic medicine. 
They thus developed a complex scheme framed in terms of 
disrupted relationships between individuals, affects of "help- 
lessness" and "hopelessness," and a state of "conservation- 
withdrawal" in which physiological function was depressed to 
the point of creating a "final common pathway" to illness and 

The Rochester groups work grew at the juncture 
between clinical studies on such diseases as leukemia and 
ulcerative colitis' 7 and a naturalistic experiment on an infant, 
"Monica," who was fortuitously admitted to Rochester's 
Strong Memorial Hospital during the course of their work. SK 
Monica had been born with a blockage in her esophagus, 
which required that two surgical openings be made, one in 
her neck to drain anything she took by mouth and one in her 

Monitoring Monica's gastric (stomach) secretions, Engel and his associ- 
ates found that physiological activity increased sharply, not only in the 
presence of food, but in the course of Monicas interactions with other, 
trusted human beings. Joyful reunions following separation were asso- 
ciated with especially copious secretions. At the same time, when 
Monica emotionally disengaged and withdrew — for example, in the 
presence of a stranger — there was a pronounced shutdown of physio- 
logical activity. In a sense, the body "withdrew" also, as if trying to 
conserve resources. 

stomach through which she could be fed. Monica did not do 
well and was admitted to the hospital at fifteen months in a 
dangerous condition. While she was being nursed back to 
health, Engel and his associates designed a study in which 
they measured her gastric secretion continuously and correlat- 
ed their observations with Monicas moods. They found that 
Monica's physiological activity increased w hen she was 
engaged with the members of the group, whether joyfully or 
angrily, and especially on reunion after separation. By con- 
trast, her gastric secretion ceased entirely, and even became 
unresponsive to histamine (which normally stimulates gastric 
secretion), w hen she withdrew physically and emotionally 
from a stranger who replaced the familiar members of the 
group. Monica's behavior made sense as a psychological and 
physiological shutdown that served to conserve her organis- 
mic resources. It also helped put into perspective the sepa- 
rately collected clinical data on patients who articulated feel- 
ings of "giving up" or being "given up" shortly before the 
onset or exacerbation of a variety of somatic diseases. 59 

By the 1970s the psychosomatic field thus had a pair 
of new concepts, one emphasizing stress-induced hyper- 
arousal and the other deprivation-caused hypoarousal. A 
major achievement of the next decade was the merger of this 
pair of ideas into one model of socio-environmental challenge 
and response and the connection of that model with other 
streams of w ork focused on "life change events" (divorce, 
bereav ement, and job loss) and "social stressors" (high inten- 
sity living and work situations and major social dislocations 
from normal support networks).'" The seventies were also 
notable for the application of progressively more sophisticated 
biostatistical techniques and more rigorous epidemiological 
study designs/' 1 Striking landmarks were Sidney Cobb and 
Robert M. Rose's study of "Hypertension, Peptic Ulcer, and 
Diabetes in Air Traffic Controllers," the 1973 conference in 
New York City on "Stressful Life Events," John Cassel's 
Wade Hampton Frost Lecture of 1976 at the American Public 
Health Association on "The Contribution of the Social 
Environment to Host Resistance," and David Jenkins's report 
in the New England Journal of Medicine the same year of sub- 
stantial evidence confirming the significance of the "Type A" 
behavior pattern as a risk factor for coronary artery disease. 62 
Although there w ere critics of some of this new w ork in psy- 
chosomatic medicine, the strong consensus in the 1970s— 
both w ithin the psychosomatic field and more broadly in sci- 
ence and medicine — was that studies on the relationship 
between social support, life stress, and disease onset were sig- 
nificant and very promising for the future." 5 It was well estab- 
lished in the popular imagination that the stress of modern 
life, work-related tension and anxiety, and devastating tragedy 
accompanied by the loss of community could lead to very 
severe health consequences. 

Also notable in the seventies was the translation of 

Dismissal (or) Pink Slip 

Howard Taft Lorenz 

The shock to the system caused by loss and broken 
trust is starkly captured in this WPA painting by Lorenz. 

Courtesy National Museum of American Art, Smithsonian 
Institution, transfer from Museum of Modern Art 

B. Kent Houston and C.R. Snyder, editors, Type A 
Behavior Pattern: Research, Theory, and 
Intervention, New York, 1 988 

Reproduced with permission from John Wiley and Sons, Inc. 


o/ rieroousn&s& c& mot/em cloi/ization/, coAccA c& (&&tifwuu&Aecl 
( from ancient />// tAe&&froe cAa/victeri&tccs/: steanybocoer, tAe 
fteriocucal ftre&& y tAe /c/cyrafi/t, tAe &cience&, and tAe mental 
at tioitu of co om t n . 

George M. Beard 

American Nervousness, Its Causes and Consequences, 1881 

new theoretical insights into practical intervention strategies, 
sometimes actively promoted by the researchers themselves. 
Thus, Meyer Friedman and Ray Rosenman, the physicians 
who initially defined the Type A concept, published a popu- 
lar book which included practical chapters on how to "re- 
engineer" one's daily life and develop "drills" to replace old 
and harmful habits." Similarly, Harvard's Herbert Benson pro- 
moted a simple, "noncultic" technique to elicit the "relax- 
ation response" as a counter to the stress-induced "emer- 
gency response." He showed that physicians could teach the 
relaxation response to patients as either a preventive or thera- 
peutic strategy.'" Several other investigators introduced 
"biofeedback" techniques (in which various physiological 
variables such as heart rate and muscle tension were dis- 
played to the patient) as practical clinical methods for manag- 
ing hypertension and a variety of other conditions."" In work 
settings, employers introduced timeouts for stress-reducing 
exercise sessions and even redesigned the production process 
itself. Of course, the time-honored "vacation in the country" 
or "stay at the spa" remained popular outlets for people's 
accumulated tension. But in a period sensitive to the impor- 
tance of loss as well as overload, health practitioners intro- 
duced newer interventions to affiliate isolated and vulnerable 
people with one another through support groups, to provide 
them with beloved objects of affection, and to encourage 
shared group solidarity of great symbolic and emotional sig- 
nificance. If stress and deprivation could cause disease, relax- 
ation and reconnection may be able to cure it or, at least miti- 
gate its effects. 

Saratoga Spa, N.Y., ca. ! 950s 

A vacation "in the country, " away from the routines of 
life, remains a tried-and-true remedy for "stress." 

Courtesy Ghilta Sternberg 










Dilbert, Scott Adams, September 1 5, 1 996 
Scott Adams, creator of the popular comic strip Dilbert, has updated the idea of "office stress" for the economically insecure 1 990s. 
© 1 996 United Feature Syndicate, Inc. 

Volvo Assembly Line, Sweden 

,n „87 ,he VCvo True, Corporal Mdated a s, g ni,can« ^^^Z^^^^^^^ ^ 

STE- — an. ep,ne^e , MlS o, ,e 

employees decreased and morale increased. 

Courtesy Volvo Truck Corporation. Powertrain Division. Skovde, Sweden 


Frontiers of the Mind 

Two of the most compelling features of the last twenty years 
have been dramatic achievements in the laboratory and strik- 
ing advances in biomedical technology. Together, they have 
literally extended the frontiers of the mind by embodying 
emotions in the biology of the brain more successfully than 
ever before and by creating the possibility of identifying the 
intricate interconnections between brain-based emotions and 
the functioning of the neuroendocrine and immune systems. 
Spectacular developments in laboratory science and visualiza- 
tion technology have been essential components of the explo- 
sive development of neuroscience, a field which has quickly 
become one of the most respected, exciting and actively pur- 
sued in medicine."" Within the neurosciences an area various- 
ly called "psychoneuroimmunology" and "neuroimmunomod- 
ulation" 68 has recently emerged which seems on the verge of 
tracing the pathways between emotions and disease whose 
connections had long been glimpsed in clinical contexts by 
physicians ranging from Galen to Freud and from 
Maimonides to Alexander. 

The modern grounding of emotional expression in 
the biology of the brain began with the work of the American 
neuroanatomist James Papez. In 1937, Papez argued from 
anatomical and clinical evidence that an "ensemble of struc- 
tures" in the lower, subcortical areas of the brain constituted 
the "anatomic basis" and "harmonious mechanism" for the 
elaboration and expression of emotions. Rejecting the possi- 
bility that emotion is "a magic product," Papez insisted that it 
is "a physiologic process which depends on an anatomic 
mechanism." 6 " Papez's ideas were effectively promoted by 
Paul MacLean, a physician and neurophysiologist. In 1949, 
MacLean proposed a hypothesized "visceral brain" as an 
anatomical and functional system intermediate between the 
"intellectual" cortex and the "discharging" hypothalamus. 
This system was "largely concerned with visceral and emo- 
tional functions." 70 In the 1950s, MacLean generalized his 
ideas into a theory of the "limbic system," an integrated set 
of subcortical structures in the brain including the hippocam- 
pus and amygdala whose precise role in emotional expression 
and modulation he explored through the electrical and chemi- 
cal stimulation of specific anatomical regions and structures." 
Other investigators added human clinical evidence and the 
results of surgery on the brains of laboratory animals, which 
also pointed to the role of the limbic system in the expression 
of emotions. 

Interest in the limbic system remained strong 
through recent times, although in the last several years neuro- 
scientists have raised questions about the looseness of some 
of the earlier theoretical assumptions and anatomical con- 
structs. They are still interested in the neural substrates of 

The organs of the immune system (thymus, spleen, 
and lymph nodes) and the organs of the neuro- 
immune system (adrenal gland, hypothalamus, and 
the cortical and subcortical brain). 


emotion within the brain bur have shifted their attention to 
the hemispheres of the cerebral cortex and to the interactions 
between cortical and subcortical regions. In the 1070s, neuro- 
seientists began to concentrate on the right cortical hemi- 
sphere as the most interesting locus of emotional control. 73 
Roger Sperry's award of the Nobel Prize in 1981 for his work 
on "cerebral laterality" (the differences between the "left" 
and the "right" brain and their behavioral significance) rein- 
forced this trend, but respected neuroseientist R.W. Doty 
indicated in a 1989 review article that "any idea of emotion 
in an intact mammal being played out purely via subcortical 
circuitry is an unsustainable abstraction. On the other hand, 
the evidence is unequivocal that subcortical structures are 
essential for the expression of the more 'primitive' emotions, 
and can support such expression in the absence of the neo- 
cortex." 74 Current work is verifying the integrative function- 
ing of cortical and subcortical areas (especially the amygdala) 
in the organism's response to primitive emotional experiences 
such as fear. 75 

Powerful new imaging techniques have supported 
and made possible the recent emphasis on the anatomical 
substrates of emotion. 7 '' The most impressive techniques are 
computer assisted tomography (CAT scans), magnetic reso- 
nance imaging (MRI), positron emission tomography (PET 



" «. " & 



Left Anterior Cingulate. 

Medial Prefrontal Cortex 



Bilateral Temporo-parietal 

Right Prefrontal Cortex 




Increased Activity in Diffuse Limbic Structure 
■-■eft =r- e frontal. 3 : latera Anterior Cingulate 
Hvsotnaia-nus. Infero-medial Prefrontal Cor-tex) 


Using PET scans, scientists are in the first stages of relating different emotional states — pleasure, sorrow — to different patterns of brain activity. 

Courtesy Mark S George, Medical University of South Carolina, 

PET scans of people who have been asked to look at. listen 
to. speak or think about a word. Different parts of the brain 
become active, depending on how the word signal is 

Courtesy Marcus E Raichle. Washington University. St. Louis. 

Thinking About Words 


scans), single-photon emission computed tomography 
(SPECT), and functional magnetic resonance imaging 
(fMRI). The breakthrough technology was computer assisted 
tomography, developed in the 1960s and 1970s, for which 
Allan Cormack and Godfrey Hounsfield received the Nobel 
Prize in 1979. The basic principle was the computer synthesis 
of a three-dimensional image from a series of two-dimension- 
al "slices" taken at multiple angles (tomography) of some sig- 
nal aimed at or emanating from the patient and detected 
outside his or her body. This principle was applied first to 
CAT scans where the measured property was an x-ray attenu- 
ation coefficient. The same principle was then applied to 
MRI imaging and PET scans, where the measured property 
was natural magnetization density in the first case and the 
concentration of an intravenously injected radioisotope in 
the second. 77 The newer fMRI is based on the tomographic 
construction of images formed by the signal differences 
between MRIs taken of the brain in functionally activated 
and non-activated states. 78 CAT scans and MRI images are 
now widely used in clinical settings to determine anomalies 
in cerebral anatomy. SPECT, PET and fMRI are valuable 
tools, at this point employed primarily in research settings 
to determine physiological and biochemical variations in 
brain activity, including anatomically-localized alterations 
in metabolism and neurochemical functioning which are 
visualized as they occur. 79 

Many of the achievements in the neurosciences have 
come at the intersection of this new imaging technology with 
recent breakthroughs in neurochemistry. 80 As one of neuro- 
chemistry's leaders, Solomon Snyder, has said, "The glue that 
has brought together findings from so many different disci- 
plines into a coherent concept of brain function is chemistry. 
Indeed the revolution is more precisely characterized as a rev- 
olution in 'molecular neuroscience.'" 81 

Twenty years ago, Snyder was among those neuro- 
chemists who succeeded in identifying opium-like molecules 
in the brain (variously called "enkephalins," "endorphins," or 
sometimes just "endogenous opioids") that helped regulate 
the sensation of pain. Endogenous opioids are a type of "neu- 
rotransmitter," a long-studied class of biochemical substances 
that convey messages from nerve fiber endings to other bio- 
logical receptors, whether nerve, muscle or gland. Neuro- 
chemists were able to identify specific opiate "receptor sites" 
where the endogenous opioids normally attach but at which 
they are sometimes displaced by exogenous competitors such 
as morphine. Using photographic techniques that take pic- 
tures of samples incorporating radioactive materials and high 
power microscopy, scientists found large concentrations of 
these receptor sites in areas of the brain (in the limbic sys- 
tem) specifically associated with pain perception and other 
forms of emotional regulation. 82 More recently and with the 
help of PET scan and fMRI technology, neuroscientists have 

Functional magnetic resonance imaging, or fMRI, is 
another new technology that can detect the living 
brain at work. This is a computer-enhanced fMRI scan 
of a person who has been asked to look at faces. The 
image shows increased blood flow in the part of the 
visual cortex that recognizes faces. 

Courtesy VP Clark, K. Keil, J. Ma. Maisog, S. Courtney, L.G. 
Ungerleider, and J.V Haxby, National Institute of Mental Health 


Optical imaging camera. 
Courtesy Photometries 

The optical imaging camera allows scientists to peer even more 
deeply into the brain, making pictures of nerve cells working togeth- 
er in ensembles. A bright light shone onto the brain reflects back 
changes in nerve cell activity (measured through changing colors 
related to water content, cell size, and amount of oxygen in the 
blood). These are then turned into colorful images. 

Courtesy Ehud Kaplan and Richard Everson, Mount Sinai School of Medicine, 
New York 

New technologies, like computerized photomicrographic 
imaging, are bringing even the microscopic world of cells 
and genes more fully into the light of day. 

Courtesy Leica Inc . Deerfield. Illinois 

The scanning electron microscope allows scientists to see 

lymphocytes, red blood cells, macrophages and monocytes. 

Courtesy Bruce Wetzel and Harry Schaefer. National Cancer Institute 

Computerized imaging microscopes combined with molecular biolo- 
gy techniques for staining tissue show activated genes in the hypo- 
thalamus at the site they are expressed (in situ hybridization). 

Courtesy Miles A. Herkenham, National Institute of Mental Health 

been able to confirm the dense distribution of opiate recep- 
tors in the structures of the limbic system and especially in 
the amygdala. Neuroscicntists thus seem to be closing in 
on both the biochemical mechanisms and the anatomical 
architecture of emotional expression in specific structures 
of the brain. 

In perhaps the most exciting development of all, a 
new field has emerged which is starting to combine the latest 
in the neurosciences with the latest in immunology to provide 
the scientific basis for understanding relationships between 
emotions and disease once explored only in clinical settings. 
Not yet possessing a generally agreed upon name, this new 
field has been able to demonstrate previously unsuspected 
but now verifiably direct connections between the immune 
system and the neuroendocrine system. The field developed 
in two waves. The first wave, rising in the late seventies 
and early eighties, was generally called "psychoneuroim- 
munology , ' (PNI). Its roots could in some sense be traced 
back to the pioneering studies of the Russian immunologist 
S. Metal'nikov at the Pasteur Institute in Paris in the 1920s 
and 1930s and to the considerable work in the Soviet Union 
from the 1920s through the 1950s on psychologically condi- 
tioned immunobiological effects. The field really began to 
take shape around 1980 under the combined leadership of the 
Americans George Solomon, Novera Herbert Spector and 
Robert Ader, the Swiss Hugo Besedovsky, and the Russian 
Elena A. Korneva. 85 Although each of these leaders came from 
a different discipline and contributed different specific exper- 
tise (Ader, for example, was an experimental psychologist, 
Solomon was a psychiatrist and Besedovsky was an endocri- 
nologist), they all agreed on the need to break down the barri- 
ers that until then had artificially separated immunology as a 
field from endocrinology and the neurosciences. As Ader and 
his colleagues put the point in 1987, "In our view, the 
attempt to understand immunity as an adaptive process that 
is independent of and can be studied in isolation from other 
integrated adaptive processes is, in its extreme form, a restric- 
tive and restricting paradigm." 84 

Beginning in the late 1980s, the second wave was 
marked by the recruitment of molecular neuroscientists. This 
phase does not yet have a fixed name, although "neuroim- 
munomodulation" (NIM) is widely accepted, while some 
leaders prefer simply "neuro-immune interactions." Some of 
the scientists recruited to the field during this phase were 
wary of PNI and remained skeptical until they were persuad- 
ed by "harder" evidence that the immune and neuroen- 
docrine systems are in fact in close and bi-directional commu- 
nication and, indeed, "talk" to each other all the time. A short 
list of discoveries early in the second wave includes the fol- 
lowing: demonstration of direct microanatomical contacts 
between the nervous and the immune systems; discovery that 
anatomical lesions in or the electrical stimulation of parts of 

Different parts of your brain share information and 
organize plans for action through a code system that 
involves both chemistry and electricity. Chemicals 
called neurotransmitters are emptied from tiny sacs 
into the space between nerve cells. These chemicals 
cross that space and bind to receptors on other nerve 
cells. The binding process triggers an electrical stimulus 
in the receiving cells, that starts the whole process of 
chemical release all over again. 


Activation of T Cells 

H«ic*r Ted ntoaotor 


When a foreign toxin or bacteria, called an antigen, enters the body, immune 
system cells race to the site of invasion. These cells are called lymphocytes 
(T and B cells) and macrophages. Receptors on the surfaces of these cells rec- 
ognize and bind to the invader. The binding process triggers the production 
of chemical signals called interleukins Interleukins allow immune cells to 
mature, communicate with each other, and to make antibodies and other 
substances that remove the invader. 

The Immune System 
and the Nervous System 

y^~^v Brain 


and Autonomic Pathways 






regulation and 

'ooo c 



_ O Cf.0 - 
LymphoWn©sc°C 1 * ~ c 

At the same time that interleukins (sometimes called 
lymphokines and monokines) allow immune cells to sig- 
nal one another, they also allow immune cells to signal 
the brain — and vice versa. 

the brain influence antibody production in the spleen and 
lymph nodes; identification of receptor sites for neuroen- 
docrine hormones and neurotransmitters on cells of the 
immune system. The "clincher" was the repeated proof 
in several different animal models that interruptions of these 
communications on a genetic, surgical, or pharmacological 
basis, lead to increased susceptibility to inflammatory dis- 
eases like arthritis. The converse is now also being shown, 
that too much responsiveness of these systems leads to 
enhanced susceptibility to infection. Now it is certain that 
particular molecules of the immune system (cytokines or 
interleukins) signal areas of the brain directly as well as exert 
influences on peripheral parts of the nervous system such 
as the vagus nerve. This rigorously demonstrated "cross-talk" 
between the immune and neuroendocrine systems 
has won over neuroscientists and gained converts among the 
immunologists themselves. Even more important, it provides 
the scientific basis for understanding — at long last — how 
emotions can in fact influence the onset, course, and remis- 
sion of disease. 

Two very different signs of enthusiasm and "arrival" 
already mark the 1990s: the inclusion of an entry on 
"Neuroendocrine Regulation of Immunity" in the 1992 
Encyclopedia of Immunology and the featuring of psychoneuro- 
immunolgy as a central theme in Bill Moyers's 1993 best sell- 


cr. Healing and flic Mind." The first indicated the acceptance 
of the new field within the mainstream of previously resistant 
immunology and the second demonstrated popular fascina- 
tion with the emerging inter-discipline. Moyers and many of 
his readers seized upon the new field as seeming to validate 
long-suspected but frequently denied connections between 
emotions and disease. A spate of high-level international sci- 
entific conferences marked by unusual energy and bold 
proclamations have added to the sense of excitement. The 
proceedings of one of these was published in 1994 as volume 
three of the "Hans Selye Symposia on Neuroendocrinology 
and Stress." The editors of the Selye volume capture the cur- 
rent mood: 

The interaction of the nervous, endocrine and immune systems is 
only now being considered seriously. This field represents a novel, 
multidisciplinary approach in Biological Sciences. Even the 
name of the field has not been settled as yet and there are debates 

going on with regards to the proper term Modern science is 

equipped with powerful research tools which make it feasible to 
advance quickly in this complex multidisciplinary field, with the 
aim of understanding the whole organism, rather than trying to 
analyze restricted areas. The developments are spectacular, 
indeed, and the new insights gained . . . have already advanced 
our understanding of certain human diseases, such as autoim- 
mune disease, in flammatory diseases, nervous and endocrine 
abnormalities and the influence of behavioral factors and of 
aging on the immune response and disease. We sincerely hope this 
volume will contribute to the understanding and acceptance of 
this brave new area of scientific enquiry. 

It may be that this "brave new area" will finally validate long 
held beliefs about emotions and disease that we in the West 
have been grappling with for at least two millennia. 



1. Sec. for example, Vivian Nutton, "Humoralism," in W.F. Bynum and 
Roy Porter, eds.. Companion Encyclopedia of the History of Medicine, Vol. I 
(London: Routledge, 1993), pp. 281-291 and Lawrence I. Conrad, et. a!., 
Tie Western Medical Tradition (Cambridge: Cambridge University Press, 

2. W.H.S. Jones, K.T. Withington and Paul Potter, eds. & trans., 
Hippocrates, Works, 6 vols. (London: Loeb Classical Library/Heinemann. 
1923-88), Vol. II, p 177. 

3. Hippocrates, op. at.. Vol. I, p. 283. 

4. Hippocrates, op. tit.. Vol. II, p. 167. 

5. Sec. for example, Heinrich von Staden, Herophilus: The Art of Medicim 
in Early Alexandria (Cambridge: Cambridge University Press, 1989). 

6. Stanley Jackson, "Galen — On Mental Disorders," Journal of the History 
of the Behavioral Sciences, 5 (1969): 366. 

7. L.J. Rather, "The 'Six Things Non-Natural,'" Clio Medica, 3 (1968): 
337-347; Saul Jarcho, "Galen's Six Non-Naturals," Bulletin of the History 
of Medicine, 44 (1970): 372-377. 

8. \ncl Bar-Sela, Hebbel E. Hoff and Elias Farus, "Moses Maimonides' 
Two Treatises on the Regimen of Health," Transactions of the Anient an 
Philosophical Society, ns, 54 (1964), Part 4: 25. 

9. Robert Burton, The Anatomy of Melancholy (1621 ), ed. A.R. Shilleto 
(London: George Bell and Sons, 1893), vol. I, p. 288. 

10. L.J. Rather, "Thomas F lenus (1567—1631) Dialectical Investigation 
of the Imagination as Cause and Cure of Bodily Disease," Bulletin of the 
History of Medicine, 41 (1967): 356. 

1 1. E rvvin H. Ackerknecht, " The History of Psychosomatic Medicine," 
Psychological Medicine, 12 (1982): 17-24. 

12. Russell C. Maulitz, Morbid Appearances: The Anatomy of Pathology in the 
Early Nineteenth Century (Cambridge: Cambridge University Press, 1987). 

13. Joel Stanley Reiser, Medicine and the Reign of 'Technology (Cambridge- 
Cambridge University Press, 1978). 

14. Leland J. Rather, Mind and Body in Eighteenth Century Medicine 
(Berkeley: University of California Press, 1965). 

15. William Cullen, First Lines of the Practice of Physic (Edinburgh: C. 
Elliot & T. Cadell, 1784), Vol. 4, p. 149. 

16. Sander L. Gilman et. al., Hysteria Beyond Freud (Berkeley: University 
of California Press, 1993) and Mark S. Micale, Approaching Hysteria 
(Princeton: Princeton University Press, 1995). 

17. Francois M. Mai and Harold Merskey, "Briquet's Treatise on 
Hysteria," Archives of General Psychiatry, 37 (1980): 1401-1405; Mai and 
Merskey, "Briquet's Concept of Hysteria: An Historical Perspective," 
Canadian Journal of Psychiatry, 26 ( 1981 ): 57-63. 


18. Christopher G. Goetz, Michel Bonduelle, Toby Gelfand, Charcot: 
Constructing Neurology (Oxford: Oxford University Press, 1995). 

19. Quoted ibid., p. 197. 

20. Kenneth Levin. Freud's Early Psychology of the Neuroses (Pittsburgh: 
University of Pittsburgh Press, 1978), p. 46. 

21. Martin Stone, "Shellshock and the Psychologists," in W.F. Bynum, 
Roy Porter and Michael Shepherd, eds., The Anatomy of Madness 
(London: Tavistock. 1985), Vol. II, pp. 242-271 and Elaine Showalter, 
The Female Malady: Women, Madness and English Culture, 1X30-1980 (New 
York: Penguin Books. 1985), pp. 167-194. 

22. Harold I. Kaplan and Helen S. Kaplan, "An Historical Survey of 
Psychosomatic Medicine," Journal of Nervous and Mental Diseases, 1 24 
(1956): 546-568 and John C. Burnham, Jelliffe: American Psychoanalyst and 
Physician (Chicago: University of Chicago Press, 1983). 

23. Martin Grotjahn, "Georg Groddeck and His Teaching About Man's 
Innate Need for Symbolization," Psychoanalytic Review, 32 (1945): 9-24. 

24. Theodore M. Brow n, "Man Gregg and the Rockefeller Foundation's 
Support of Fran/. Alexander's Psychosomatic Research," Bulletin of the 
History of Medicine, 61 (1987): 155-182. 

25. Benjamin V. White. Stanley Cobb: A Builder of the Modern Neurosciences 
(Boston: Francis A. Countway Library of Medicine, 1984), pp. 212, 

26. Gerald N. Grob. From Asylum to Community: Mental Health Policy in 
Modern America (Princeton: Princeton University Press, 1991), p. 17 and 
N athan G. Hale, The Rise and Crisis of Psychoanalysis in the United States 
(New York: Oxford University Press, 1995), pp. 187-202. 282. 

27. Gail Thain Parker, Mind Cure in New England 1 1 Ianover NH: 
University Press of New England, 1973) and Robert C. Fuller, Alternative 
Medicine and American Religious Life (New York: Oxford University Press, 

28. William James. The Varieties of Religious Experience (New York: 
Longmans, Green, and Co., 1902), p. 94. 

29. Ibid., p. 122. 

30. Quoted in Rennie B. Schoepflin, Lives on Trial: Christian Science 
Healers in the Progressive Era (University of Wisconsin Doctoral 
Dissertation: Madison. 1995), p. 210. 

31. Donald Meyer. The Positive 'Thinkers (New York: Pantheon Books, 
1980), p. 168. 

32. Ernest Kurtz, Not-God: A History of Alcoholics Anonymous (Center City, 
MN: Hazelden, 1979). 

33. Meyer, op. at., pp. 177-194, 259-289. 

34. See, for example, Norman Cousins, Anatomy of an Illness (New York: 
WAV. Norton, 1979) and Head First: The Biology of Hope (New York: E.P 
Dutton, 1989). 


35. James Harvey Young, The Toadstool Millionaires: A Social II is/on of 
Patent Medicines in America Before Federal Regulation (Princeton: Princeton 
University Press, 1961) and The Medical Messiahs: \ Social History of 
Health Quackery in Twentieth-Century America (Princeton: Princeton 
University Press, 1967). 

36. Paul Starr, The Social Transformation of American Medicine (New York: 
Basic Books, 1982), pp. 127-134. 

37. Daniel Hack Tuke, Illustrations of the Influence of the Mind I T pon the 
Body in Health and Disease, Second American Edition (Philadelphia: 
Henry C. Lea's Son & Co., 1884), p. 439. 

38. O.H. Perry Pepper, "A Note on the Placebo," American Journal of 
Pharmacy, 117 (1945): 409^412 and Arthur K. Shapiro, "The Placebo 
Effect in the History of Medical Treatment," American Journal of 
Psychiatry, 116 (1959): 298-304. 

39. Lewellys F. Barker, "Psychotherapeutics," Transactions of the 
Association oj American Physicians, 23 (1908): 478. 

40. C. Macfie Campbell, "Psychiatry and the Practice of Medicine," 
Boston Medical and Surgical Journal, 190(1924): 1058. 

41. W.R. Houston, "The Doctor Himself as a Therapeutic Agent," 
Annals of Internal Medicine, 11 (1938): 1418. 

42. Sec, for example, Thomas Findley, "The Placebo and the 
Physician," Medical Clinics of North America, 37 (1953): 1821-1826 and 
Louis Lasagna, et. al., "A Study of the Placebo Response," American 
Journal of Medicine, 16 (1954): 770-779. 

43. Louis Lasagna, "Placebos," Scientific American, 193 (August, 1955): 

44. Henry Byerly, "Explaining and Exploiting Placebo Effects," 
Perspectives in Biology and Medicine, 19 (1976): 423^136. 

45. Priscilla Grevert and Avram Goldstein, "Placebo Analgesia, 
Naloxone, and the Role of Endogenous Opioids," in Leonard White, 
Bernard Tursky, and Gary E. Schwartz, eds., Placebo: Theory, Research, ami 
Mechanisms (New York: Guilford Press, 1985), pp. 332-350. 

46. Chase P. Kimball, "Conceptual Developments in Psychosomatic 
Medicine: 1939-1969," Annals of Internal Medicine, 73 (1970): 307-316; 
Z.J. Lipowski, "Psychosomatic Medicine in a Changing Society: Some 
Current Trends in Theory and Research," Comprehensive Psychiatry, 14 
(1973): 203-215; Z.J. Lipowski, "Psychosomatic Medicine in the 
Seventies: An Overview," American Journal of Psychiatry, 134 (1977): 

47. Nathan G. Hale, The Rise and Crisis of Psychoanalysis in the United 
States (New York: Oxford University Press, 1995), p. 322. 

48. Ibid., pp. 312; 323-324; 326-327; 449, n. 43; 451-453, n. 3-8; 13-16. 
See also Robert Aronowitz and Howard M. Spiro, "The Rise and Fall of 
the Psychosomatic Hypothesis in Ulcerative Colitis," Journal of Clinical 
Gastroenterology, 10 (1988): 298-305. 


49. Eliot Slater, "Diagnosis of 'Hysteria,'" British Medical Journal, 1 
(1965): 1399. 

50. Bela Mittelmann and Harold G. Wolff, "Emotions and 
Gastroduodenal Function," Psychosomatic Medicine, 4 (1942): 5-61 and 
Harold G. Wolff, "Protective Reaction Patterns and Disease," Annals of 
Internal Medicine, 27 (1947): 944-969. 

51. Harold G. Wolff, Stress and Disease (Springfield IL: Charles C. 
Thomas, 1953). 

52. Montreal: Acta, Inc., Medical Publishers, 1950. See also Hans Selye, 
"The Evolution of the Stress Concept," American Scientist, 61 (1973): 

53. Quoted in John W. Mason, "A Historical View of the Stress Field," 
Part \, Journal of Human Stress, 1 (March, 1975): 10. 

54. S. Szabo, "The Creative and Productive Life of Hans Selye: A 
Review of His Major Scientific Discoveries," Experienria, 41 (19X5): 
564-567 and V. Tache, "A Tribute to the Pioneering Contributions of 
Hans Selye: An Appraisal Through His Books," Experientia, 41 (1985): 

55. John W. Mason, "A Historical View of the Stress Field," Part II, 
Journal of Human Stress 1 (June, 1975): 22-36. 

56. Arthur H. Schmale, "Relationship of Separation and Depression to 
Disease," Psychosomatic Medicine, ns., 20 (1958): 259-277; George L. 
Engel, "A Life Setting Conducive to Illness," Annals of Internal Medicine, 
69 (1968): 293-300; George L. Engel and Arthur H. Schmale, 
"Conservation-Withdrawal: A Primary Regulatory Process for Organismic 
Homeostasis," in Physiology, Emotion & Psychosomatic Illness, Ciba 
Foundation Symposium 8, ns (Amsterdam: Elsevier-Excerpta Medica, 
1972), pp. 57-85. 

57. William A. Greene, Jr., "Psychological Factors and 
Reticuloendothelial Disease," Psychosomatic Medicine, 16 (1954): 220-230 
and George L. Engel, "Biologic and Psychologic Features of the 
Ulcerative Colitis Patient," Gastroenterology, 40 (1961): 313-317. 

58. George L. Engel, Franz Reichsman, and Harry L. Segal, "A Study of 
an Infant With a Gastric Fistula," Psychosomatic Medicine, 18 (1956): 
374_398 and George L. Engel and Franz Reichsman, "Spontaneous and 
Experimentally Induced Depressions in an Infant With a Gastric- 
Fistula," Journal of the American Psychoanalytic Association, 4 (1956): 

59. A.H. Schmale, "Giving Up as a Final Common Pathway to Changes 
in Health," in Z. J. Lipowski, ed., Psychosocial Aspects of Physical Illness 
(Basel: Karger, 1972), pp. 20^10. 

60. George L. Engel, "The Need for a New Medical Model: A 
Challenge for Biomedicine," Science, 196 (1977): 129-135 and George L. 
Engel, "The Clinical Application of the Biopsychosocial Model," 
American Journal of Psychiatry, 137 (1980): 535-543. 

61. Z.J. Lipowski, "Psychosomatic Medicine: An Overview," Modern 
Trends in Psychosomatic Medicine, 3 (1976): 1-20. 


62. Cobb and Rose, JAMA. 224 (1973): 489-492; Barbara Sncll 
Dohrenwend and Bruce P. Dohrenwend, eds., Stressful Life Events: Their 
Nature and Effects (New York: John Wiley & Sons, 1974); John ( lassel, 
"The Contribution of the Social Environment to Host Resistance," 
American Journal of Epidemiology 104 (1976): 107-123; C. David Jenkins, 
"Recent Evidence Supporting Psychologic and Social Risk Factors foi 
Coronary Disease," New England Journal of Medicine, 294 (1976): 

63. Evelyn L. Goldberg and George W. Comstock, "Life Events and 
Subsequent Illness." American Journal of Epidemiology, 104(1976); 
146-158; Sidney Cobb, "Social Support as a Moderator of Lite Stress." 
Psychosomatic Medicine, 38 (1976): 300-314; Judith G. Rabkin and Elmer 
L. Struening, "Life Events, Stress, and Illness," Science, 194 (1976): 

64. Meyer Friedman and Ray Rosenman, Type A Behavior and Your Heart 
(Nev, York: Alfred A. Knopf, 1974), Chapts. 16 & 17. 

65. Herbert Benson, The Relaxation Response (New York: Morrow. 1975). 

66. See, for example, Lee Birk, ed.. Biofeedback: Behavioral Medicine (New 
York: Crime and Stratum, 1973). 

67. Francis (). Schmitt, " The Neurosciences Research Program: A Brief 
History," in Fred Samson and George Adelman, eds., The Neurosciences: 
Baths of Discovery II (Boston: Birkhauser, 1992), p. 15, points out that the 
Soc iety for Neuroscience, which was founded in 1970 with an initial 
membership of 200, had grown to 13,500 members by 1989. 

68. George Adelman, ed.. Encyclopedia of Neuroscience (Boston: 
Birkhauser, 1987), pp. 798-799 and 1001-1004. 

69. James W. Papez, "A Proposed Mechanism of Emotion," Archives of 
Neurology and Psychiatry, 38 (1937): 725-743, esp. 743. 

70. Paul D. MacLean, "Psychosomatic Disease and the 'Visceral Brain,'" 
Psychosomatic Medicine, 11 (1949): 338-353, esp. 351. 

71. Paul D. MacLean and Jose M.R. Delgado, "Electrical and Chemical 
Stimulation of Frontotemporal Portion of Limbic System in the Waking 
Animal." Electroencephalography and Clinical Neurophysiology, 5 ( 1953): 
91-100 and Paul D. MacLean, "Chemical and Electrical Stimulation of 
Hippocampus in Unrestrained Animals," Archives of Neurology and 
Psychiatry. 78 (1957): 113-142. 

72. Antonio R. Damasio and (JAY. Van Hocsen, "Emotional 
Disturbances Associated with Focal Lesions of the Limbic f rontal 
Lobe," in Kenneth Heilman and Paul Sat/., eds.. Neuropsychology of 
Human Emotion (New York: Cuilford Press, 1983), pp. 85-1 10. 

73. Norman Ceschwind, "Specializations of the Human Brain," Scientific 
American, 241 (September, 1979): 192. 

74. R.W. Doty, in Guido Gainotti and Carlo Caltargirone, eds., Emotions 
and the Dual Brain (Berlin: Springer- Verlag, 1989), pp. 56-82. 

75. Joseph E. LeDoux, "Emotion, Memory and the Brain," Scientific 
American, 270 (June, 1994): 50-57. 

76. See, for example, John C. Mazziotta and Michael E. Phelps, 


"Metabolic Evidence of Lateralized Cerebral Function Demonstrated 
by Positron Emission Tomography in Patients With Neuropsychiatric 
Disorders and Normal Individuals," in D. Frank Benson and Kran 
Zaidel, eds.. The Dual Brain (New York: Guilford Press, 1985), pp. 
181-192 and Frank B. Wood et. al., "Cerebral Laterality in Functional 
Neuroimaging," in Frederick L. Kitterle, ed., Cerebral Laterality: Theory 
and Research (Hillsdale NJ: Lawrence Erlbaum Associates, 1991), pp. 

77. Nancy C. Andreasen, ed.. Brain Imaging: Applications in Psychiatry 
(Washington: American Psychiatric Press, 1989). 

78. Jeffrey R. Binder and Stephen M. Rao. "Unman Brain Mapping w ith 
Functional Magnetic Resonance Imaging," in Andrew Kertesz, ed.. 
Localization and Neuroimaging in Neuropsychology (San Diego: Academic 
Press, 1994), pp. 185-212 and John A. Sanders and William W. Orrison, 
"Functional Magnetic Resonance Imaging." in William W. Orrison, et. 
al.. Functional Brain Imaging (St. Louis: Mosby, 1995), pp. 239-326. 

7 l ». Marcus E. Raichle. "Visualizing the Mind," Scientific American, 270 
(April, 1994): 58-64. 

80. For a lively account of neurochemistry in the 1970s, see Charles F. 
Levinthal, Messengers of Paradise: Opiates and the Brain (New York: 
Anchor/Doubleday, 1988), esp. pp. 70-109. 

81. Solomon H. Snyder, "Drugs, Neurotransmitters, and the Brain," in 
Pietro Corsi, ed., The Enchanted Loom: Chapters in the History of 
Neuroscience (New York: Oxford University Press, 1991), p. 299. 

82. Solomon H. Snyder, "Opiate Receptors and Internal Opiates," 
Scientific American, 236 (March, 1977): 44-56; cf. Leslie L. Iversen, "The 
Chemistry of the Brain," Scientific American, 241 (September, 1979): 

83. For a brief historical overview, see Ruth Lloyd, Explorations in 
Psychoneuroimmunology (Orlando, FL: Grune & Stratton, 1987), Chapt. 1. 
For a collection of the critical papers that helped shape the discipline, 
see Steven Locke et. al., eds., Foundations of Psychoneuroimmunology 
(New York: Aldine, 1985). The seminal book that contained major 
review articles by the leading Figures and that most dramatically 
launched the field was Robert Ader. ed.. Psychoneuroimmunology (New 
York: Academic Press, 1981). 

84. Robert Ader, Nicholas Cohen, David L. Felten, "Editorial: Brain, 
Behavior, and Immunity," Brain, Behavior, and Immunity, 1 (1987): 5. 

85. Bryan M. Gebhardt and J. Edwin Blalock, "Neuroendocrine 
Regulation of Immunity," in Ivan M. Roitt and Peter J. Delves, eds., 
Encyclopedia of Immunology (London: Academic Press, 1992), pp. 

86. Bill Movers, Healing and the Mind (New York: Doubleday, 1993) pp. 

87. Edited by Istvan Berczi and Judith S/elenyi, Hans Selye Symposia on 
Neuroendocrinology and Stress (New York: Plenum Press, 1994). 

88. Ibid., p. vii. 


Checklist for Emotions and Disease 

Galen. Opera ex Sexta Juntarum Editione, Venice, 

Johann Engel (1463-1512). Astrolabium Planum in 
Tabulis Ascendens, Augsburg, 1488 

Robert Burton (1577-1 640), The Anatomy of 
Melancholy, Oxford. 1 632 

In the list that follows, classmarks (call numbers) have been 
provided only for items from the collections of the National 
Library of Medicine. All measurements, when available, are 
given in centimeters unless otherwise noted. 

The Balance of Passions 

Walther Ryff (d. 1548), Spiegel and Regiment der Gesundheyt, 
Frankfurt, 1555. Graphic: Photographic reproduction of wood- 
cut illustration, (illustrated page viii) 

A Long Tradition 

Johannes de Ketham (fl. 1455-1470), Fasciculus Medicinae, 
Vienna, 1495. Book: 31 (h) x 43 (open width) WZ240 K43f 
1495. (illustrated page 2) 

Description of the Humoral system. Graphic: Photographic- 
reproduction of illustration with English translation of the 
original Latin text. Based on an original illustration in 

Fasciculus Medicinae. (illustrated page 2) 

Hippocrates (ca. 460 B.C.-ca. 370 B.C.), Hippokratous . . . 
latrike, Basel, 1543. Book: 15 (h) x 21 (open width). WZ240 
H667 1543. (illustrated page 2) 

Galen (131-201), Opera ex Sexta Juntarum Editione, Venice, 
1586. Book: 36.5 (h) x 48.5 (open width). WZ 240 G153L 
1586 v. 1. (illustrated page 52) 

Galen (131-201), Opera ex Sexta Juntarum Editione, Venice, 
1586. Graphic: Photographic reproduction of illustration of a 
lovesick maiden taken from title page illustration, (illustrated 
page 3) 

Johann Engel (1463-1512), Astrolabium Planum in Tabulis 
Ascendens, Augsburg, 1488, copy 1. Book: 25.5 (h) x 37.5 (open 
width). WZ230 A585a 1488 c.l. (illustrated page 52) 

Gregor Reisch (d. 1525), Margarita Pkilosophica cum 
Additionibus Novis, Basel, 1517. Book: 21.5 (h) x 36 (open 
width). WZ240 R375m 1517. (illustrated page 4) 

Gregor Reisch (d. 1525), Margarita Pkilosophica rum 
Additionibus Novis, Basel, 1517. Graphic: Photographic repro- 
duction of illustration of profile of head, (image unavailable 
for catalogue) 


Moses Maimonides (1135-1204), Tractates Rabbi Moysi de 
Regimine Sanitatis ad Soldanum Regem, Augsburg, 1518. Book: 
20 (h) \ 28 (open width). WZ240 M911tL 1518. (illustrated 
page 4) 

Justus Cortnummius (ca. 1624-1675 m.), DeMorbo Attonito 
Liber Unus, Leipzig, 1677. Book: 21 (h) x 33 (open width). 
WZ250 C8298dm 1677. (illustrated page 3) 

Ambroise Pare (1510P-1590), The Workes, London, 1649. Book: 
33 (h) x 45.5 (open width). WZ250 fP227E 1649. (illustrated 
page 5) 

Honore Daumier (1808-1879), Bobonne, Bobonne, tu me ferais 
tin monstre com me fa, ne le regarde pas tant!, 1860s. Lithograph: 
33 (h) x 25 (w). (illustrated page 6) 

Robert Burton (1577-1640), The Anatomy of Melancholy, 
Oxford: Printed for Henry Cripps, 1632. Book: 29 (h) x 37.5 
(open width). WZ250 B9745a 1632. (illustrated page 52) 

William Falconer (1744-1824), .4 Dissertation on the Influence of 
the Passions Upon the Disorders of the Body, London, 1788. Book: 
20.5 (h) x 27 (open width). WZ260 F179d 1788. (illustrated 
page 6) 

Bloodletting lancet, 19th century. Lancet: 1/2" (h) x 1" x 
(w) 2" (1). Courtesy Historical Collections, The National Museum of 
Health and Medicine, Armed Forces Institute of Pathology, 
Washington, D.C. (illustrated page 53) 

Scarificator, 19th century. Scarificator: 2" (h) x 1" (w) x 2" (1). 

Courtesy Historical Collections, The National Museum of Health and 
Medicine, Armed Forces Institute of Pathology, Washington, D.C. 
(illustrated page 53) 

Artificial leech, 1879. Leech: 5" (h) x 1" (dia). Courtesy 
Historical Collections, The National Museum of Health and 
Medicine, Armed Forces Institute of Pathology, Washington, D.C. 
(illustrated page 53) 

Johannes de Ketham (fl. 1455-1470), Fasciculus Medicinae, 
Vienna, 1495. Graphic: Photographic reproduction of illustra- 
tion of bloodletting sites, (illustrated page 53) 

These mechanical bloodletting devices were used by 
physicians in the nineteenth century an indication of 
the long persistence of humoral practice in medicine, 
even after the partial eclipse of humoral theory in the 
seventeenth century. 

Johannes de Ketham (fl. 1455-1470), Fasciculus 
Medicinae, Vienna, 1495. 


Joseph Woodward used this microscope in his pioneer- 
ing work as a microscopist The mirror reflected the 
light from a window through the microscope and 
onto a photoplate. thereby allowing Woodward — or 
other scientists — to photographically capture certain 
features of cells. 

Courtesy Historical Collections. The National Museum of Health 
and Medicine. Armed Forces Institute of Pathology. 
Washington. D.C. 

This autopsy kit from ca. 1845 shows instruments more 
refined than those of the sixteenth century, although 
their basic design is not much altered. 

Courtesy Historical Collections. The National Museum of 
Medical History. Armed Forces Institute of Pathology. 
Washington. D C. 

The Challenge of Anatomy 

Vndrcas Vcsalius (1514-1564), De Humani Corporis Fabrica, 
Venice, 1568. Book: 32.5 (h) x 45 (open width). WZ240 
fV575d 1568. (illustrated page 7) 

Andreas Vesalius (1514-1564), De Humani Corporis Fabrica, 
Venice, 1568. Graphic: Photographic reproduction of illustra- 
tion of autopsy/dissection tools, (illustrated page 7) 

Thomas Willis (1621-1675). The Remaining Medical Works oj 
Thomas Willis, London. 1679. Book: 54 (h) x 46.5 (open 
width). WZ250 fW35phE 167 u a. (illustrated page 8) 

Rudolf Virchow (1821-1902), Die Cellularpathologie in ihrer 
Begrundung auf Physiologische und Pathologist Gewebelehre, 
Berlin, 1858. Book: 22 (h) x 29.5 (open w idth). QSA V813c 
1858. (illustrated page 9) 

Rudolph L.K. Virchow. Photograph: 16.5 (h) x 11 (w). (illus- 
trated page 9) 

Rend Theophile Hyacinthe Laennee (1781-1826), De 
V Auscultation Mediate, ou, Traitedu Diagnostic des Maladies des 
Poii dioiis et (hi Coeur (On Mediate Auscultation, or. Treatise on the 
Diagnosis of the Diseases of the Lungs and Heart), Paris, 1819. 
Book: 21 (h) x 26 (open width with illustration). WF L158de. 
(illustrated page 8) 

Postcard of Laennee, A I'Hopital Necker, Ausculte Un Phtisique, 
original painting by Theobald Chartran (1849-1907). 
Postcard: 15.7 (h) x 12 (w). (illustrated page 8) 

Laennec-style stethoscope. Stethoscope: 10" (1) x 1.5" (dia). 

Courtesy Historical Collections, The National Museum of Health and 
Medicine, Armed Forces Institute of Pathology, Washington, D C. 
(illustrated page 8) 

Microscope, 1864. 11" (h) x 16" (1) x 9.5" (d). Courtesy 
Historical Collections, National Museum of Health and Medicine, 
Armed Forces Institute of Pathology, Washington, D C. (illustrated 
page 54) 

Alexandar Levy, Woodward Working in the Laboratory, ca. 1952. 
Graphic: Photographic reproduction of illustration, (image 
unavailable for catalogue) 

Autopsy/dissection kit, ca. 1845. 1" (h)x 3" (w) x 7" (1) 
closed. Courtesy Historical Collections, National Museum of Health 
and Medicine, Armed Forces Institute of Pathology, Washington, 
D C. (illustrated page 54) 


Edouard Hamman (1819-1888), Andreas Vesalius, ca. 1848. 
Lithograph: 31.2 (h) 40.2 (w). (illustrated page 7) 

Lucia Rosetti, The University of Padua, An Outline of Its History, 
Trieste, 1983. Courtesy Esther Sternberg, (image unavailable tor 

The Compromise 

William Cullen (1710-1790). FirstLines of the Practice of Physic, 
Edinburgh, 1784. WZ260 C967f 1784. (illustrated page 10) 

Robertv Whytt (1714-1766). Observations on the Nature, Causes, 
and Cure of Those Disorders Which Have Been Co mm only Called 
Nervous, Hypochondriac, or Hysteric, Edinburgh, 1765. Book: 
20.5 (h) x 28 (open width), (illustrated page 55) 

Austin Llint (1812-1886), .4 Treatise on the Principles and 
Practice of Medicine, Philadelphia, 1868. WB F623t 1868. (illus- 
trated page 11) 

Psychosomatic Medicine: 
The "Puzzling Leap" 

Andre Brouillet, UneLegon C Unique a la Sa/petriere, 1887. 
Graphic: Photographic reproduction of painting. B4519. (illus- 
trated page 12) 

Camera, ca. 1900. Camera: 16" (h) x 16" (w) x 42" (1). Courtesy 
Historical Collections, The National Museum of Health and 
Medicine, Armed Forces Institute of Pathology, Washington, D.C. 
(illustrated page 14) 

Desire-Magloire Bourneville (b. 1840) and Paul Regnard, 
Iconographie Photograph ique de la Salpetriere, Paris, 1877-1880. 
Graphics: Two Photographic reproductions of two patients 
with hysteria, (illustrated page 14) 

Honore Daumier (1808-1879), Le malade imaginaire, 1860s. 
Lithograph. Courtesy Penny Herscovitch. (illustrated page 13) 

Josef Breuer (1842-1925) and Sigmund Freud (1856-1939), 
Studies on Hysteria, New York, 1957. WM173 B846s 1957. 
(illustrated page 15) 

Berggasse 19, Sigmund Freud s Home and Office, Vienna 1938, The 
Photographs of Edmund Engelman, Chicago, 1976. CC2656. 
(image unavailable for catalogue) 

Robert Whytt (1714-1766), Observations on the 
Nature, Causes, and Cure of Those Disorders 
Which Have Been Commonly Called Nervous, 
Hypochondriac, or Hysteric, Edinburgh, 1765 


Double Portrait of the Artist in Time 

Helen Lundeberg 

Psychosomatic medicine traced the diseases suffered as 
an adult back to the developmental dramas and trau- 
mas of early childhood. 

Courtesy National Museum of American Art. Smithsonian 
Institution, Washington. D C 

Sidney Chafetz, Portrait of Sigmund Freud, 1964. Etching: 69 
(h) \ 56 (w). (illustrated page 15) 

H. Flanders Dunbar (1902-1959), Emotions and Bodily 
Changes: A Survey of Literature on Psychomatic Interrelationships, 
1910-1933, New York, 1935. Book: 24.5 (h) x 35.5 (open 
width). WM90 D898e 1935 (illustrated page 18) 

Psychosomatic Medicine. September-October 1959. 
Wl P582. (illustrated page 18) 

Smith Ely Jelliffe (1866-1959), "Psyche-pathology and 
Organic Disease," Sketches in Psychosomatic Medicine, New York, 
1939. Wl NE211 no.65 1939. (image unavailable for cata- 

Georg Groddeck (1866-1934), The Book of the It, New York, 
1928. Book: 23 (h) x 32.5 (open width). Wl NE21 1 v. 49. 
(illustrated page 17) 

Franz Alexander (1891-1964), Psychosomatic Medicine, New 
York. 1950. Book: 22 (h) x 31.5 (open width). WM90 A375p 
1950. (image unavailable for catalogue) 

Franz Alexander (1891-1964), Psychosomatic Medicine, New 
York, 1950. Graphic: Photographic reproduction of schematic- 
representation of specificity in the etiology of the peptic 
ulcer, (illustrated page 19) 

Helen Lundeberg (1908- ), Double Portrait of the Artist in Time, 
1935. Graphic: Photographic reproduction of oil painting. 

Courtesy National Museum of American Art, Smithsonian institution, 
Washington, D C. (illustrated page 56) 

Roy Grinker (1900-1993 ) and John P. Spiegel, War Neuroses in 
North Africa: The Tunisian Campaign (January-May, 1943). 
Prepared and distributed for the Air Surgeon, Army Air 
Forces by the Josiah Macy, Jr. Foundation, New York, 
September 1943. Book: 23 (h) x 15 (w). WM184 G867w 1943. 
(illustrated page 18) 

Roy Grinker (1900-1993 ) and John P. Spiegel, Men Under 
Stress, Philadelphia, 1945. Book: 33 (h) x 23 (w). WM184 
G867m 1945. (illustrated page 18) 

Thomas W. Salmon (1876-1927), The Care and Treatment of 
Mental Diseases and War Neuroses ("Shell Shock") in the British 
Army. War Work Committee of the National Committee for 
Mental Hygiene, New York, 1917. Book: 24.5 (h) x 46.5 (open 
width with illustration). US 629 S172c 1917. (illustrated 
page 16) 


Frank Loesser (1910-1969), "Adelaide's Lament," Guys and 
Dolls, 1950. © 1950, 1978 Frank Music Corporation. Sheet 
music and lyrics. Donated by Lou Storey, (image unavailable for 

Self-Healing, Patents, and Placebos, 

Pharmaceutical Era, February 1889. Graphic: Photographic 
reproduction of illustration of pharmacy designed and built by 
C.H. Bangs, (illustrated page 21) 

Pharmacy Bottle. Bottle: 26" (h) x 6" (dia). Courtesy Elaine and 
Arthur Shapiro, (illustrated page 57) 

Benjamin Rush (1746-1813), .4// Inquiry into the Effects of 
Ardent Spirits upon the Human Body and Mind, with an Account 
of the Means of Preventing, and of the Remedies for Curing Them, 
New York, 1811. Book: 17 (h) x 21.5 (open width). WZ270 
R952i 1811. (illustrated page 21) 

Albert Vernon, Correspondence Course of Instruction in the Science 
of Psych ratism or Prowess of the Human Mind, Rochester, New 
York, The Vernon Academy of Mental Sciences and The 
Vernon Sanatorium, 1900. Book: 17.5 (h) x 53.5 (open width). 
BF Y539c 1900. (illustrated page 57) 

Julia Anderson Root, Healing Power of Mind: A Treatise on 
Mind-Cure, with Original Views on the Subject and Complete 
Instructions for Practice and Self-Treatment, Peoria, Illinois, 1886. 
Book: 20.5 (h) x 32.5 (w). WM R806h 1886. (illustrated page 

Notman, William James, Graphic: Photographic reproduction 
of a photograph. B15230. (illustrated page 22) 

Mirror with gilt frame (with Emile Coue quote), ca. 1920. 
Courtesy Elizabeth Fee. (image not available for catalogue) 

Charles Fremont Winbigler (1857-1925), How to Heal and 
Help One's Self or a New Outlook on Life, Los Angeles, 1916. 
Book: 20 (h) x 14 (w). QT180 W758h 1916. (illustrated 
page 57) 

John Kearsley Mitchell (1859-1917), Self Help for Nervous 
Women: Familiar Talks on Economy in Nervous Expenditure, 
Philadelphia, 1909. Book: 20 (h) x 14 (w).WM M675s 1909. 
(illustrated page 57) 

"Laughter is the Best Medicine," Reader s Digest, April 1958. 
Magazine: 7" (h) x 10" (w). Courtesy Ghilta Sternberg, (illustrat- 
ed page 23) 

Pharmacy Bottle. 

Courtesy Elaine and Arthur 

Albert Vernon, Correspondence Course of 
Instruction in the Science of Psychratism or 
Prowess of the Human Mind, Rochester, New York, 
The Vernon Academy of Mental Sciences and The 
Vernon Sanatorium, 1 900 

Charles Fremont Winbigler (1857-1925), How to 
Heal and Help One's Self or a New Outlook on 
Life, Los Angeles, 1916 

John Kearsley Mitchell (1859-1917), Self Help for 
Nervous Women: Familiar Talks on Economy in 
Nervous Expenditure, Philadelphia, 1 909 


Dale Carnegie (1888-1955), How to Stop Worrying and Stan 
Living, New York, 1985, © 1944. Book: 6" (h) \ 4" (w ). (image 
unavailable for catalogue) 

Thomas A. Harris (1913- ), I'm Okay — You're OK, New York, 
1973, ©1967. Book: 7" (h) \ 4" (w). (illustrated page 23) 

Norman Vincent Peale ( 1889-1994), The Power of Positive 
Thinking, New York. 1992, ©1952. Book: 7" (h) x 4" (w ). 
(illustrated page 23) 

Perkins's Metallic Tractors, late 18th century. Tractors: .V (I) 
x 1/2" (w ). Courtesy Historical Collections, The National Museum of 
Health and Medicine, Armed Forces Institute of Pathology, 
Washington, D C. (illustrated page 25) 

John Haygarth, Of the Imagination as a Cause and as a Cure of 
Disorders of the Body; Exemplified by Fictitious Tractors, and 
Epidemical Convulsions, Bath, 1800. Book: 21.5 (h) \ 27.5 (w). 
WZ260 1 14210 1800. (illustrated page 25) 

Benjamin Douglas Perkins (1774-1810), The Family Remedy; 
or, Perkins's Patent Metallic 'inn tors, For the Relief of Topical 
Disease of the Human Body; And of Horses, 1800. Pamphlet: 22.5 
(h) \ 14.5 (w ). WBC P448e 1801. (illustrated page 25) 

Unicorn horn. I lorn: 73" (h) x 4" (dia). Courtesy Elaine and 
Arthur Shapiro, (illustrated page 24) 

Kickapoo Oil: Relief from Aches and Pains. Courtesy Elaine 
and Arthur Shapiro, (illustrated page 24) 

Nerve & Bone Liniment. Courtesy Elaine and Arthur Shapiro, 
(illustrated page 24) 

Dr. Pierce's Favorite Prescription. Courtesy Elaine and Arthur 
Shapiro, (illustrated page 24) 

Hood's Sarsaparilla, Gentian and Bitter Orange Compound. 
Courtesy Elaine and Arthur Shapiro, (illustrated page 24) 

Bliss Native Balsam. Courtesy Elaine and Arthur Shapiro, (illus- 
trated page 24) 

Swamp Root. Courtesy Elaine and Arthur Shapiro, (illustrated 
page 24) 

Milks Emulsion Natures Remedy. Courtesy Elaine and Arthur 
Shapiro, (illustrated page 24) 

Krso Anti-Bilious Bitters. Courtesy Elaine and Arthur Shapiro, 
(illustrated page 24) 


Pastor Koenig's Nervine for Nervous Aliments. Courtesy Elaine 
and Arthur Shapiro, (illustrated page 24) 

Goldine Tonic and Nervine. Courtesy Elaine and Arthur Shapiro, 
(illustrated page 24) 

Ads Compound Syrup Hypophosphites (Hear. Courtesy Elaine 
and Arthur Shapiro, (illustrated page 24) 

Dr. Pierce's Golden \ledieal Discovery. Courtesy Elaine and 
Arthur Shapiro, (image unavailable for catalogue) 

Powered unicorn horn. Courtesy Elaine and Arthur Shapiro, 
(illustrated page 24) 

Four Batteries. Batteries: 1" (dia) to 1" (dia). Courtesy Elaine 
and Arthur Shapiro, (illustrated page 25) 

Humphrevs' Remedies sign. Sign: 16" (h) x 12" (w). Courtesy 
Elaine and Arthur Shapiro, (illustrated page 24) 

Warner's Safe Cure Almanac and Book of Handy Information 
1895. Buffalo, New York. Book: 22 (h) x 15.5 (w). W6 P3 no. 
7475. (illustrated page 24) 

Portrait of William Osier. Graphic: Photographic reproduction 
of painting. 20142. (illustrated page 26) 

Milk Sugar. Bottle: 5" (h) x 2" (dia). Courtesy Elaine and Arthur 
Shapiro, (illustrated page 28) 

Antilirium Placebo. Bottle: 4" (h) x 2" (dia). Courtesy Elaine 
and Arthur Shapiro, (illustrated page 28) 

Cebocap No. 1. Bottle 2" (h) x 1" (dia). Courtesy Elaine and 
Arthur Shapiro, (illustrated page 28) 

Cebocap No. 2. Bottle 2" (h) x 1" (dia). Courtesy Elaine and 
Arthur Shapiro, (illustrated page 28) 

Cebocap No. 3. Bottle 2" (h) x 1" (dia). Courtesy Elaine and 
Arthur Shapiro, (illustrated page 28) 

Nardil Placebo. Courtesy Elaine and Arthur Shapiro, (illustrated 
page 29) 

Placebo for Elavil HC1. Courtesy Elaine and Arthur Shapiro, 
(illustrated page 29) 

Placebo for Stela/ine. Courtesy Elaine and Arthur Shapiro, (illus- 
trated page 29) 


Placebo tor Valium. Courtesy Elaine and Arthur Shapiro, (illus- 
trated page 29) 

fon I). Levine, Newton C. Gordon, Howard L. Fields, "The 
Mechanism of Placebo Analgesia," The Lancet, September 23, 
1978. Book: 28 (h) x 38 (open width). Wl LA453. (illustrated 
page 29) 

"Pain Pathways." Graphic: Photographic reproduction of illus- 
tration. Courtesy Alfred Mansour, Mental Health Research Institute. 
University of Michigan, (image unavailable for catalogue) 

Stress and Deprivation 

Peter Gridley, Long Island Expressway. Graphic: Photographic 
reproduction of photograph, (illustrated page 30) 

Chris Todd, "Noise Pollution." Audio recording. 

Walter Bradford Cannon. Graphic: Photographic reproduction 
of photograph. B30295. (illustrated page 32) 

Walter Bradford Cannon (1871-1945), Bodily Changes in Pain, 
Hunger, Fear and Rage: An Account of Recent Researches into the 
Functions of Emotional Excitement, New York, 1915. BF511 
G266b 1915. (illustrated page 32) 

Walter Bradford Cannon (1871-1945), The Wisdom of the Body, 
New V,„k, 1939. QT104 C226W 1939. (image not available 
for catalogue) 

1 lans Selye (1907-1982), The Physiology and Pathology of 
Exposure to Stress, Montreal, 1950. Book: 24.8 (h) x 39.5 (open 
width). QZ140 S469p 1950. (illustrated page 33) 

American Journal of Nursing, March 1965. Wl AM495. (illus- 
trated page 34) 

Readers Digest, February 1957. Magazine: 19 (h) x 27 (open 
width). Courtesy Ghilta Sternberg, (illustrated page 33) 

How ard Taft Lorenz, Dismissal (or) Pink Slip, 1940. Graphic: 
Photographic reproduction of oil painting. Courtesy National 
Museum of American Art, Smithsonian Institution, transfer from 
Museum of Modern Art. (illustrated page 35) 

Excerpts from Monica Study, 1950s. Video. Courtesy Dr. George 


Monica, 1950s. Graphic: Photographic reproduction of six 
original photographs of Monica. Courtesy Dr. George Engel. 
(illustrated page 34) 

2/26/54 Applegate, Histamine laboratory "flowsheets." 
Graphic: Photographic reproduction of original laboratory 
notes. Courtesy Dr. George Engel. (illustrated page 34) 

B. Kent Houston and C.R. Snyder, editors. Type A Behavior 
Pattern: Research, Theory, and Intervention, New York, 1988. 
Book: 24 (h) x 36 (w). WG300 T991 1988. (illustrated 
page 35) 

Robert Dantzer, The Psychomatic Delusion, New York, 1993. 
1993 A261. (image unavailable for catalogue) 

Defuse Stress, Health Dynamics Poster Program. ©1988 
Clement Communications, Inc. Poster: 56 (h) x 43.2 (w). 
A25395 (image unavailable for catalogue) 

Kai T. Erickson, Everything in Its Path, New York, 1976. 
Donated by Lou Storey, (image unavailable for catalogue) 

Barry J. Marshall, Richard W. McCallum, Richard L. 
Guerrant, editors, Helicobacter Pylori in Pept'n Ulceration and 
Gastritis, Boston, 1991. YYI310 H475 1991. (image unavailable 
for catalogue) 

Scott Adams, Dilbert, September 15, 1996. Graphic- 
Photographic reproduction of cartoon. © 1996 United Feature 
Syndicate, Inc. (illustrated page 37) 

Volvo Assembly Line, Sweden, ca. 1987. Graphic: Two photo- 
graphic reproductions of the assembly line. Courtesy Volvo 
Truck Corporation, Powertrain Division, Skovde, Sweden, (illustrat- 
ed page 37) 

Saratoga Spa, N.Y., ca. 1950s. Postcard: 3" (h) x 5". Courtesy 
Ghilta Sternberg, (illustrated page 36) 

Betty White with Thomas J. Watson, Betty White's Pet-Love: 
How Pets Take Care of Us, New York, 1983. Book: 21.5 (h) x 30 
(open width). DD8254. (illustrated page 61) 

Cindy Ruskin, photographs by Matt Herron, The Quilt: Stories 
from the NAMES Project, New York, 1988. Courtesy Nola Heffner. 
(image unavailable for catalogue) 

Betty White with Thomas J. Watson, Betty White's 
Pet-Love: How Pets Take Care of Us, New York, 

Some hospitals, hospices and nursing homes have dis- 
covered that patients feel calmer and less depressed in 
the presence of a loving, furry friend — some may even 
Pecome more stable physiologically or recover more 
quickly from their illness as a result of their involvement 
in "pet therapy." 

Photograph credits (I to r): Courtesy of People-Pet Partnership 
Program; Flossie Stowell; Courtesy of People-Pet Partnership 
Program, Courtesy of People-Pet Partnership Program. Used by 
permission of William Morrow & Co., Inc. 


Frontiers of the Mind 
1 low Emotions Matter 

Positron Emission Tomography (PET scanner). Graphic: 
Photographic reproduction. Courtesy GE Medical Systems (illus- 
trated page 38) 

Emotions and Disease: The Delicate Balance, 1996. Video, 
Produced by the National Library of Medicine with 
Multimedia Software Inc. for the exhibition Emotions and 

Tiger in the wild (including close-up). Graphic: Photographic 
reproduction from Emotions and Disease video. Courtesy 
National Geographic Television, (image unavailable for cata- 

Fear-response system. Graphic: Photographic reproduction of 
Emotions and Disease video illustration. Illustrated by Bob 
I loward Computer Graphics, (image unavailable for cata- 
logue ) 

Neurotransmitters. Graphic: Photographic reproduction from 
Emotions and Disease video. Illustrated by Bob How ard 
Computer Graphics, (illustrated page 43) 

Optical imaging camera. Camera: 14.4 (h) x 13.21 (w) x 21.9 
(d). Courtesy Photometries, Ltd. (illustrated page 42) 

Image created by optical imaging camera. Graphic: 
Photographic reproduction of imaging camera output. Courtesy 
Ehud Kaplan and Richard Everson, Mount Sinai School of Medicine, 
New York, (illustrated page 42) 

PET scans of brain activity during transient sadness and hap- 
piness. Graphic: Photographic reproductions of PET scans. 

Courtesy Mark S. George, Medical University of South Carolina, 
Charleston, (illustrated page 40) 

PET scans of brain activity of people w ho have been asked to 
look at, listen to, think about or speak a word. Graphic: 
Photographic reproduction of PET scans. Courtesy Marcus E. 
Raichle, Washington University, St. Louis, Missouri, (illustrated 
page 40) 

Functional magnetic resonance image (fMRI) of brain activity 
of a person looking at faces. Graphic: Photographic reproduc- 
tion of fMRI. Courtesy VP Clark, K. Keil, J. Ma. Maisog, 
S. Courtney, L.G. Ungerleider, and J.V Haxby National Institute of 
Mental Health, (illustrated page 41 ) 


Activation of T-cells. Graphic: Photographic reproduction of 
illustration, (illustrated page 44) 

Molecular structure of interleukin-1. Graphic: Photographic 
reproduction of illustration. Courtesy. Angela Gronenborn, 
National Institute of Diabetes and Digestive and Kidney Diseases. 
Illustrated by Bob Howard Computer Graphics, (image 
unavailable for catalogue) 

The Immune System and the Nervous System. Graphic: 
Photographic reproduction of illustration, (illustrated page 44) 

Physician examining a sick child. Graphic: Photographic 
reproduction. Courtesy National Institute of Allergy and Infectious 
Diseases, ((image not available for catalogue) 

Computerized photomicrographic microscope. Graphic: 
Photographic reproduction. Courtesy Leica Inc., Deerfield, Illinois, 
(illustrated page 42) 

In situ hybridization. Graphic: Photographic reproduction of 
imaging microscope output. Courtesy Miles A. Herkenham, 
National Institute of Mental Health, (illustrated page 42) 

Normal circulating human blood. Graphic: Photographic- 
reproduction of scanning electron microscope output. Courtesy 
Bruce Wetzel and Harry Schaeffer, National Cancer Institute, (illus- 
trated page 42 ) 

Researcher and DNA sequencing gel. Graphic: Photographic 
reproduction. Courtesy National Institute of Allergy and Infectious 
Disease, ((image not available for catalogue) 

A Dynamic Balance 

Overactive hypothalamus. Graphic: Photographic reproduc- 
tion of Emotions and Disease video illustration. Illustrated by 
Bob Howard Computer Graphics, (image not available for 

An overactive amygdala. Graphic: Photographic reproduction 
of Emotions and Disease video illustration. Illustrated by Bob 
Howard Computer Graphics, (illustrated page 40) 

Interruption of the brain/immune system communication. 
Graphic: Photographic reproduction of Emotions and Disease 
video illustration. Illustrated by Bob Howard Computer 
Graphics, (image not available for catalogue) 


Immune system stuek in the on position. Graphic: 
Photographic reproduction of Emotions and Disease video illus- 
tration. Illustrated by Bob Howard Computer Graphics, 
(image not available for catalogue) 

Imbalance in the chemical transmission between neurons. 
Photographic reproduction of Emotions and Disease video illus- 
tration. Illustrated by Bob Howard Computer Graphics, 
(image not available for catalogue) 



This project was made possible by the generous support of 
the Charles A. Dana Foundation, the John I), and Catherine 
r. MacArthur Foundation, the Fetzer Institute, and the 
National Institute of Mental Health. 

Project Staff 

Esther M. Sternberg, M.D. 
National Institute of Mental Health 

Exhibit 'io a Dit n to r 

Elizabeth Fee, Ph.D. 
National Library of Medicine 
Exhibition Dit i ■< tor 

Anne Harrington, Ph.D. 

Harvard University, Cambridge MA 

Visiting Curator, Exhibition Script Writer 

Theodore M. Brown. Ph.D. 

University of Rochester, Rochester NY 

Visiting Can/tor, Exhibition Catalogue Essay Author 

Gretchen Hermes, Washington DC 
Assistant Curator 

Patricia Tuohy, Washington DC 

Exhibition Manager; Managing Editor, Catalogue 

Anne Whitaker 

National Library of Medicine 

Collections Manager 

Edwina Smith, Washington DC 

Exhibition Coordinator 

Mary Parke Johnson 
National Library of Medicine 


Margaret Kaiser 
Elizabeth Tunis 
National Library of Medicine 


Roxanne Beatty 

National Library of Medicine 

Invitation Coordinator 


William Leonard 

National Library of Medicine 

Audiovisual Coordinator 

Joe Fitzgerald 

National Library of Medicine 

Chief of Graphics 

Troy Hill 

National Library of Medicine 

Graphic Designer 

I )csign and Production 

Lou Storey Red Bank NJ 
Exhibition I )> 'signt r 

Multimedia Software, Inc., Frederick MD 

Emotions and Disease: A Delicate Balance 
1 ideo Producer 

Exhibits Unlimited, Inc., Alexandria VA 

Exhibition and Graphic Fabricator 

Technical Vrtistry, New York NY 
/ . igfiting Designer 

Donors and Lenders to the Exhibition 

George L. Engel 
Elizabeth Fee 
Mary Garofalo 
Nola Heffner 
Penny Herscovitch 

Historical Collections, The National Museum of Health 

and Medicine, Armed Forces Institute of Pathology, 
Washington DC 

Photometries Ltd, Tucson AZ 

Elaine and Arthur Shapiro 

Esther Sternberg 

Ghitta Sternberg 

Lou Storey 


Exhibition Photographs and Graphics 

Scott Adams 

V.P. Clark, K. Keil, J. Ma. Masog, S. Courtney, 

L.G. Ungerleider, andJ.V. Haxby, 

National Institute of Mental Health 
George L. Engel 

GE Medical Systems, Milwaukee Wl 

Mark S. George, Medical University of South Carolina, 

Peter Gridley/FPG 

Angela Gronenborn, National Institute of Diabetes and 

Digestive and Kidney Diseases 
Miles A. Herkenham, National Institute of Mental Health 
Ehud Kaplan and Richard Everson, Mount 

Sinai School of Medicine 
Leica, Inc., Deerfield IL 

Alfred Mansour. University of Michigan, Ann Arbor 
National Cancer Institute 

National Institute of Allergy and Infectious Diseases 
National Geographic Television 

National Museum of American Art, Smithsonian Institution 
Marcus E. Raichle, Washington University 

School of Medicine. St. Louis 
United Media, New York NY 
Volvo Lastvagnar. Skovde, Sweden 

Bruce Wetzel and Harry Schaefer, National Cancer Institute 

Let There Be Light video excerpts 


Brian Matthews 

National Library of Medicine 


Open captions and laser disk provided by Audiovisual 
Program Development Branch, Lister Hill National Center 
for Biomedical Communications, NLM 


Mon nd Story video excerpts 

Video and Images 

Courtesy Dr. George L. Engel 

Monica Archives Committee, University of Rochester, 
Rochester NY 


Tim Shea 

1 )epartment of Psychiatry 

I fniversity of Rochester Medical School 

I 'isual Consultant 

Brian Matthews 

National Library of Medicine 


Open captions and laser disk provided by Audiovisual 
Program Development Branch, Lister Hill National Center 
for Biomedical Communications, NLM 

Emotions and Disease: A Delicate Balance video 

Video and Images 

The Arthritis Foundation 

V.P ( Hark, K. Keil, J. Ma. Maisog, S. Courtney, 

L.G. Lngerleider, and J.V. Haxby, National Institute 

of Mental Health 
"Digital Anatomist" team at University of Washington 

including: Dr. Cornelius Rosse, Dr. John Bolles, 

Dr. John W. Sundsten, Dr. James Brinkley, 

Draig Eno, Jeffery Prothero, Roger Williams 
Historical Collections, The National Museum of Health 

and Medicine, Armed Forces Institute of Pathology, 

Washington DC 
History of Medicine Division, National Library of Medicine 
Mark S. George, Medical University of South Carolina, 


Miles A. Herkenham, National Institute of Mental Health 
Ehud Kaplan and Richard Everson, Mount Sinai 

School of Medicine 
National Institute of Allergy and Infectious Diseases 
National Institute of Mental Health 
National Institute of Mental Health/DART 
National Institute of Diabetes and Digestive 

and Kidney Diseases 
National Cancer Institute 
National Geographic Television 

"Luncheon of the Boating Party" Reproduced courtesy 
oi I he Phillips Collection, Washington DC 



Esther M. Sternberg, M.D. 
National Institute of Mental Health 

Executive Producer, Script Writer 

Mare Montefusco 
Multimedia Softw are, Inc. 

Bob Howard Computer Graphics 
Art Direction, Animation, Digital Video Editing 
and Special Effects 

Paul Rose 
Charizmah, Inc. 
Composer, Original Score 

Special Advisors 

Michelle Trudeau 

National Public Radio, Irvine CA 

James Louie, M.D. 

Division of Rheumatology, Harbor-ICLA Medical Center 

Dr. C. Liana Bolis 

World Health Organization 

Dr. Rex Cow dry 

National Institute of Mental Health 

Dr. Scott Durum 
National Cancer Institute 

Dr. Suzanne Felten 
University of Rochester 

Dr. Jonathan Fritz 

National Institute of Mental Health 

Dr. Angela Gronenborn 

National Institute of Diabetes and Digestive 
and Kidney Diseases 

Dr. Pierre Henkart 
National Cancer Institute 

Dr. Steven Hyman 

National Institute of Mental Health 


Dr. Ehud Kaplan 

Mount Sinai School of Medicine 

Dr. Joseph LeDoux 
Ncm York University 

Dr. Ludise Malkova 

National Institute of Mental Health 

Dr. Bruce McKwen 
Rockefeller University 

I )r. Mortimer Mishkin 

National Institute of Mental I lealth 

Dr. Jon New som 
Library of Congress 

1 >r. Stanley Pillemer 

National Institute of Arthritis and Musculoskeletal 
and Skin Diseases 

I )r. Marcus E. Raichle 

Washington University School of Medicine 

Dr. Harry Z. Rami 

National Museum of American Art 

( lonsulting Panel 

C. Liana Bolis, M.D. 

I )i\ ision of Mental 1 lealth 

World Health Organization 

Ary Goldberger, M.D. 

Beth Israel Hospital 

Harvard Medical School, Boston MA 

Lynn (i. Gordon, Ph.D. 
Fetzer Institute, Kalamazoo MI 

Vyacheslav Ivanov, Ph.D. 

University of California, Los Angeles, CA 

Institute of World Culture, Moscow University 

Ehud Kaplan. Ph.D. 

M ount Sinai School of Medicine, New York NY 

Joseph LeDoux. Ph.D. 

New York University, New York NY 


William R. Lovallo, Ph.D. 
Mind-Body Network. Chicago IL 
MacArthur Foundation, Chicago IL 

Bruce McEwen, Ph.D. 

Rockefeller University, New York NY 

Socierv for Neuroseience, Washington DC 

Declan Murphy, Ph.D. 

DMR Management Group, halls Church VA 

Jon Newsom, Ph.D. 

Library of Congress, Washington DC 

Marcus E. Raichle, M.D. 

Washington University School of Medicine. St. Louis MO 
Harry Z. Rand. Ph.D. 

National Museum of American Art. Washington DC 

Douglas Smith, Ph.D. 

Boston Museum of Science, Boston M A 

Fred Steiner, Ph.D. 
Composer, Santa Fe NM 


Special Thanks 

Donald A.B. Lindberg, M.D., Director, National Library 
of Medicine 

Jules Asher, National Institute of Mental Health 

Maggie Bartlett, National Cancer Institute 

Rick Becker, Department of Psychiatry, University 

of Rochester Medical School 
Lois Ann Colaianni, Associate Director for 

Library Operations, National Library of Medicine 
Rex W. Cowdry, Acting Deputy Director, National 

Institute of Mental Health 
Isabel Davidoff, National Institute of Mental Health/DART 
Kathleen Gardner Cravedi, Special Expert, Office of 

Public Information, National Library of Medicine 
Daniel Garrett, National Institute of Diabetes 

and Digestive and Kidney Diseases 
\h in Harris, Deputy Chief, Office of Administration, 

National Library of Medicine 
Steven E. Hyman, Director, National Institute 

of Mental Health 
Joy Jackson, NIH Video Unit 

Karlton Jackson, Staff Photographer, National Library 

of Medicine 
I )onna Kerrigan, National Cancer Institute 
Karen Leighty, National Institute of Allergy 

and Infectious Diseases 
Robert Mehnert, Chief, Office of Public Information, 

National Library of Medicine 
Pamela Meredith, Head, Public Services Division, 

National Library of Medicine 
Elizabeth G. Rosso, Assistant Administrative Officer, 

National Library of Medicine 
Kent A. Smith, Ph.D., Deputy Director, National Library 

of Medicine 

Patricia Williams, Administrative Officer, National Library 
of Medicine 

Theodore E. Youwer, Chief, Office of Administration, 
National Library of Medicine 

Additional Thanks 

\l \brams, Bethesda MD, print broker 
Litho Impressions, VA, brochure printer 
Frame of Mine, Washington DC, framing 
Jeff Watts, Staff Photographer, Infinite Color, Arlington VA, 

catalogue photography 
Chroma Graphics, Inc., Largo MD, catalogue printer